Permalink for this paragraph0
The workhouses of London “have their enjoyments” at least one day of the year, The Morning Post reported in 1872,[1] and accordingly at Christmas the residents of MAB hospitals received their special feast. Imbecile patients at the asylums were provided roast beef, plum-pudding, beer, fruit, tobacco and snuff as well as “other luxuries in celebration of the festival” in “handsomely decorated” surroundings. The inmates of the infectious hospitals, meanwhile, made due with “such maimed rites as the necessity of the various cases demanded.” As paupers, they were benefitting from the honored tradition of treating the destitute to a sumptuous Christmas repast (usually funded by private donations, since the Poor Law generally forbade such extravagancies to be provided out of the rates). Newspapers conventionally reported on enormous quantities of food lavished to paupers on the merry day,[2] and sometimes wondered if the “workhouse system cannot be so very bad which permits, and in fact sanctions, the annual Christmas feast for the poor.”[3] Yet, as everyone must have known, this single and circumscribed day of bounteous generosity merely marked a temporary suspension the otherwise year-round rule of strict parochial austerity. It was also “a season when public and private losses and gains are being reckoned,”[4] and for a range of observers the holiday occasioned a review of success by the state in stamping out improvidence and idleness. The same articles commemorating the annual workhouse feast were prefaced and interspersed with statistics anxiously recording an increase of pauperism or cheering its decline over the previous year.[5] The festivities’ smug hypocrisy was the central theme of George Sims’s popular poem, “In the Workhouse: Christmas Day.” In it, an old male inmate explains why “a penniless pauper spits on your paltry feast”: his wife had starved to death the previous Christmas because the parish would not allow her bread at a crucial moment.[6] Sims revived the visceral trope of degrading parochial food classically lodged in Oliver Twist, but brought it up to date with recent changes in the metropolitan Poor Law. Indeed, by the time the infectious patients of the MAB enjoyed their “maimed” holiday meal in 1872 they would be aware that, while the state now provided special hospitals for the treatment of their dangerous illnesses, they were nonetheless made to perform the unsavory rites of pauperism.

Permalink for this paragraph0
The MAB infectious disease hospitals emerged during a period of growing debate about the meanings of pauperism and the conditions of institutional relief. Indeed, the 1860s witnessed both a powerful retrenchment of official austerity under groups like the Charity Organisation Society as well as a successful movement for the humanitarian reform of the internal situations of workhouses. The MAB owed its origin in 1867 to the publically scandalous state of the parochial sick wards. The MAB reflected the close association between the management of pauperism and the management of public health that was a hallmark of “state medicine” at this time. Yet its creation also signaled that the foremost challenge to the principles of the 1834 New Poor Law would be the widely recognized anomalous position of London’s sick poor. Infectious patients presented a particularly difficult puzzle piece. While the London charity hospitals were busily competing for the best reputation in comfort and liberality, pauper establishments like those of the MAB carried the burden of the mid-Victorian Poor Law and were forced to adhere to official principles of deterrence. From the beginning, however, the MAB’s patients — victims of epidemics, most of whom would never have otherwise risked being associated with parish aid and yet were swept into the newly available institutions during periods of confusion and panic — actively contested their sudden and unwelcome status as paupers. For decades by this time, the workhouse had popularly signified not only the political economy of austerity and self-reliance, but also the institutionalization of repulsive treatment and punitive shame. It sought to discipline appetite in accordance with industriousness. Not considered a reformatory of manners, the Victorian workhouse was instead a laboratory for formulating the proper modes of civility and consumption by marking the pauper as separate and abject. Given the infamous association of pauper treatment with “coarse fare,” it is not surprising that the first MAB patients sensed the insinuation of pauperism primarily in their food. And so it should be useful to examine the cultural history of the workhouse diet as it relates to popular assumptions about the vulgar deprivations of pauperism.

Permalink for this paragraph0
Using “taste” as a discursive signpost, this chapter maps the repugnant reputation of London workhouses and plots it against the attempts of rate-supported infectious patients to negotiate their dire status. Quite apart from the dreadful sensory experience of diseases like smallpox, scarlet fever, typhoid and typhus fever, patients also had to manage the social disgrace that could accompany residence in a pauper hospital. This was clear to a reporter for The Echo who surveyed the ravages of smallpox among the “respectable poor” and was impressed by the scorn that met any offer of parochial assistance. “The horror of pauperism among this class exceeds their horror of the small-pox, and well it might, for, on the whole, if it is not a more terrible disease, [pauperism] is one from which there is far less hope of recovery.”[7] Reflecting middle-class Victorian pride in independence against adversity, this author finds their resistance pitiable, but mostly laudable. As we shall see, that horror of pauperism determined the initial reception of London’s medical isolation system and structured the dramatic narratives of those at the center of a public scandal over conditions at the Hampstead Smallpox Hospital in 1871. Patients emotionally resented being treated like paupers. In fact, they were only nominally “paupers” residing in a “workhouse” and did not match the conventional description of the destitute. This ambiguity enabled patients to frame themselves as persons out-of-place. They repudiated the pauper taint by laying claim to higher standards of comfort and taste. Hospital food emerged as a key symbolic issue through which patients discussed the broader issue of how the institution failed their own individual principles of domesticity. The hospital was distasteful and disgusting, as a workhouse was expected to be, but not as they deserved.

Permalink for this paragraph0
“Taste classifies, and it classifies the classifier.”[8] As a tool of social and cultural distinction, Pierre Bourdieu famously argued, taste is both relational and discursive. “Taste” of course has long served as general shorthand for a broad range of cultural and moral judgments, from aesthetics to cuisine and from the appreciation of pleasure to the acquisition of reason. It provides a plentiful field for studying the micropolitics of social posturing and the subtle public strategies of inclusion and exclusion.[9] Taste, however, is also orchestrated through the material and social performance of bodies. Wolfgang Schivelbusch, for instance, sees a close intertwining of “symbolic meaning and actual physical taste” amidst the development of the spice trade in late-medieval Europe: “Social connections, balance of power, wealth, prestige, and all manner of fantasies were ‘tasted’: what would become matters of social and cultural ‘taste’ or fashion, were first matters of physical tasting.”[10] The social history of food has often been framed around questions of availability or abundance, ecology and trade, foodways and the borderlands between culinary groups. Sidney Mintz produced the classic work on taste and contingent, malleable desire. More recently, James Vernon intriguingly suggests a political history to how hunger has been defined and mobilized in the service of governing the modern subject.[11] A massive and growing literature on the history of consumption tends to support the view that “taste” in goods appeared at least by the eighteenth century as a primary means by which British society ordered the possession and performance of status. Along these lines, there is now a copious school of analysis that places Victorian “respectability” within the commodity culture of domestic comforts.[12] All ranks of society were by this time engaged in this extended discourse on the material furnishings of domesticity, deftly managing rules of high complexity and sometimes organizing new patterns of display and consumption. The material markers of domestic civility, according to a recent generation of working-class history, seem to have been integral methods of practicing social citizenship among the artisan and lower-middle classes (or at least maintaining the veneer of deference, as Peter Bailey proposes).[13] A broad literature has therefore arisen touching upon taste and citizenship in Victorian Britain, which centers upon the ability of proper consumption to signify proper political fitness.[14] The spaces for the practice of civility, we should remember, were constantly under contention and negotiation, as is stressed by the theoretical literature interested in Victorian taste’s reliance upon definitions of the vulgar, the low, and the abject.[15] Which brings us back again to the importance of pauperism in structuring Victorian notions of taste. Paupers could not feel “at home” in the workhouse — that was essentially forbidden. The Poor Law was founded upon a “sensibility of discomfort”[16] that sought to classify paupers by their distance from taste and comfort.

Permalink for this paragraph0
The Victorian workhouse was supposed to draw a firm moral line between the “independent crust” and “unearned crumb.” As pauper establishments too, the MAB hospitals immediately produced a public arena for articulating a caustic popular friction between those categories of respectability and abjection. Linking the history of medical isolation with the history of the workhouse enables us to appreciate of the place of physical sensation in the production of social discourse, while at the same time also view the ways that discourse mediated the meaning of hospitals’ corporeal and tactile experiences. After exploring how this political economy of taste was both performed and resisted in the new pauper hospitals, the next two chapters will expand upon adjacent questions: What might the history of civil rights and social citizenship look like from the perspective of this institutional discourse on civility? How did the discourse and experience of isolation change once the ideology of parochial deterrence was removed from medical treatment on the rates? Surely, notions of taste and civility go to the heart of concepts of a cooperative, sanitary citizen’s body. This study underscores that the pauper body, a crucial site of Victorian governance, was a contested concept and an elusive object of detention. Sick “paupers” confounded many of the ordinary strictures of “undeserving” and “abject.” These conventions were liable to contention by many if not most of the first patients, and a critical dimension of that conflict took place along the body politics of taste and food.

Permalink for this paragraph0
The Poor Law Amendment Act of 1834 (the New Poor Law) transformed state relief for the poor into an abiding ideological statement of middle-class values: liberalization of economy and government; fetishization of work, thrift and self-help; rationalization of sexual restraint. It was “the single most important piece of social legislation ever enacted,” in the words of David Englander.[17] The eleemosynary principles of the new system had two broad immediate goals: reducing the poor rates and spurring industriousness amongst the laboring classes. The newly emerging economic system was premised upon wage fluidity and labor discipline, and in this first era of liberal political economics pauperism was repurposed into a powerful symbol of an individual’s earthly failure and moral repugnance. The workhouse provided the symbolic core of this approach — indeed, a physical object-lesson in the penalties now sought for idleness. As a practical mechanism of deterrence, the undesirability of the parish “House” was the primary means to test the applicant’s actual need and also to deny other aid to those deemed undeserving. One Assistant Poor Law Commissioner memorably insisted that viewed from the outside it should be physically imposing and act as a “terror to the able-bodied population.”[18] Internal semiotics were to serve the same purpose. The model workhouse “should be a place of hardship, of coarse fare, of degradation and humility,” the Reverend H. H. Milman explained to the New Poor Law’s chief architect, Edwin Chadwick; “it should be administered with strictness—with severity; it should be as repulsive as is consistent with humanity.”[19]

Permalink for this paragraph0
The workhouse pauper was surrounded with other penalties that constituted a detailed micropolitics of social ostracism and physical humiliation. Subjected to austere surroundings, dissection after death,[20] separation from family members,[21] distinctive garb,[22] and “coarser food,” the inmate was positioned within an innovative architecture of both abjection and training. Placed in Foucauldian terms, as Felix Driver does, the workhouse system can be seen as rooted in a new political rationality of the body that extended far beyond the walls of these institutions for managing idleness. He places the workhouse “at the intersection of two histories, those of modern government and institutional discipline.”[23] The Poor Law fashioned a new subject—a target of legislative goals, administrative philosophies and those disciplining discourses that produced, but were also constitutive of, “society.”[24] Discursively, the pauper was now the radical Other of the idealized domestic realm; the workhouse the antithesis of the home and its comforts, of the family and its affections, of the family budget and the tastes which guide responsible purchases. Historians have long questioned whether the New Poor Law’s punitive principles were enforced in all or even most circumstances. And indeed, the reality of pauperism must be complicated, involving local variation as well as resistance and workhouse regime as well as other forms of humiliating deterrents.[25] Yet, while in reality a complicated and capricious figure, the emotionally powerful presence of the pauper in the Victorian social imagination was far from ambiguous.[26] The emotionally powerful resonance of the pauper burial, Thomas Laqueur and Ruth Richardson demonstrate, achieved full bloom under the Victorians not only as a way of signifying parochial parsimony, but also publishing a deeply humiliating sign of personal worthlessness. It is an indication of the importance of officially-endorsed degradation and shame.[27] Traced in its barest forms through legal and administrative changes, the meaning of pauperism can perhaps be understood best by searching for its symbolic place in popular culture. Protean and malleable as the label could be, the stigma attached to the pauper was as deliberate and focused as any cultural formation can be said to be.

Permalink for this paragraph0
The Victorian workhouse sought to impose a harsh gastronomical penalty upon pauperism. The Poor Law Commission investigator, Sir Francis Bond Head, was typical in typecasting the abuses of the Old Poor Law in explicitly culinary terms; he instead promoted the New Poor Law as a means of “grinding down” pauperism. Head argued that parochial relief had long operated upon “false principles of arrant gluttony,” and that easily obtainable food had valorized mere brute gratification amongst paupers. Rather than aiding the march of the mind, it had fostered “the swinish government of the belly.” The implications for society were clear: misguided state charity had condescended “to stuff the pauper at the expense of the lean rate-payer” and inverted the natural order envisioned by these philosophers of political economy. “Poor is the diet of the pauper in the poorhouse; Poorer is the diet of the small rate-payer; Poorest is the diet of the independent labourer.”[28] Advocates of the New Poor Law like Head sought to invert this perverse hierarchy of consumption. The foundational principles of this new regime drew upon the teachings of Malthus and Bentham: the effects of aid needed to be shielded from the market, labor performed for relief must not deprive any independent laborer of sustenance, and the quality of relief could in no way be superior to that earned by the independent laborer (the principle of “less eligibility”). Ensuring that paupers were allowed only the “poorest” diet clearly meant imposing a subsistence regime, but one also deliberately starved of meaning and taste. Paupers possessed mouths to fill, not palates to placate. Meat could only be wasted on paupers, who had already proven themselves incapable of appreciating the moral qualities of that powerful “patriotic emblem”: roast beef.[29] Thus, food became the keynote in a chorus of pragmatic claims to “protect the rates,” but it also carried deep symbolic significance for citizenship and independence. Imposing a low subsistence upon paupers would, in Head’s mind, raise the pleasure and esteem of the ordinary British diet and allow the respectable poor to better perform the sensibilities of humble, yet tasteful, citizenship.

Permalink for this paragraph0
The 1834 reformers framed pauperism as a problem of disordered appetite and subsequently an issue of social and political unfitness. They framed a discourse deriving from Malthusian concepts of population, which assumed that generous aid under the old system “had created more labourers than work.”[30] The promise of gratuitous food fed other, libidinal, appetites. According to Head and a host of similar commentators, it led the “rude, amorous ploughman” to not consider the disadvantages of early marriage. In particular, the possibility of receiving “heavy lumps of savoury food” from the parish was the same as the parish offering him “the blooming girl of his heart.” And, for Head, “the warm bribe, like the bride, must be irresistible.”[31] This lack of parochial restraint was a symbol for, and a backing of, the poor’s lack of sexual restraint. As management of desires started with the mouth (and continued through to rational husbandry, fatherhood and citizenship), male paupers necessarily made prodigal family heads, and therefore also untrustworthy political subjects. The danger of this immoral entitlement was clear in the age of rural revolts and Chartist agitation, with Head repeatedly returning to the theme of a dietary-induced social decay. Nourishment on the parish cultivated not only indolence but intimidation amongst the lower orders, leading inexorably toward “the most dreadful of all revolutions.”[32] Fortunately, Head envisaged, “as soon as the poor-house shall cease to be attractive” and a “healthy reluctance” created among the indolent, “a manly desire to support themselves will instantly burst into being.[33] Rhetorically merging national and corporeal bodies (or bellies?), Head promised that the national health would be restored, and the corruption of “gouty charity” conquered, once the workhouse became “wholesomely repulsive” and devoid of the corruptively enticing “smell of hot joints.”[34] Resisting free food, therefore, was a key test of a man’s political fitness. The New Poor Law stipulated that the spirit of independence (that bastion of English liberties) must be more nourishing than any sustenance served in the parochial trough.

Permalink for this paragraph0
Caustically deprecated in Oliver Twist, the “pauper’s gruel” formed a central disciplinary tool in the model workhouse regime and continues to provide an abiding, visceral metaphor for the Poor Law’s deprivation and debasement.[35] The vulgar term for all varieties of mass-produced London workhouse soup was “skilly” (or “skilligolee,” also known as prison gruel[36]), famed for its principled cheapness, monotony, roughness, blandness, and cold efficiency of distribution. The economical dietaries also served the purpose of symbolically placing recipients outside the sphere of discriminating choice and confining them to the realm of bodily necessity. The Poor Law Board reminded unions in 1867 that workhouse diets should aim at a perfectly balanced economy of principled distaste and practical palatability. They had to be kept “plain and wholesome;” not so revolting as to cause food to be wasted, but bland enough not to encourage paupers to savor their nourishment.[37] Salt, for example, was the only officially recognized flavoring. Meat, to the extent it was served at all, was almost always boiled instead of roasted (and exacting means were attempted to calculate the average loss of flesh in cooking and serving[38]). Disorderly and refractory paupers could be punished with further dietary reductions, such as restrictions to dry bread, boiled potatoes and water — which of course strengthened suspicions that the ordinarily meager pauper fare was already a form of punishment. And yet this semiotics of corporeal deprivation was also productive of scientific discourses on human needs and limits. John Coveney notes that the rationalization of pauper dietary (calculating the physiological moment of starvation) helped initiate the modern science of nutrition.[39] There was “no obligation to give [paupers] more than the quantity and quality [of food] which will serve the ends of existence,” explained a pioneering early nutritionist. “Hence it is that when a subsistence ration is to be studied, scientific men all over the world go to these institutions for data.”[40] Workhouses hosted spaces necessary for supporting scientific consumption models, but also for promoting the bond between modes of consumption and civic identity.

Permalink for this paragraph0
Food proved a polemic cornerstone in highly charged debates over the austere ideology guiding parochial relief. William Cobbett among others was convinced the new mantra of suppressing pauperism contained draconian Malthusian designs.[41]The Times, reflective of conservative criticism, labeled the New Poor Law the “Starvation Act.”[42] More acerbically, The Figaro in London opined:

Permalink for this paragraph0
The thought that “a hungry man is an angry man” worried many observers anxious about the maintenance of social order amidst the Chartist agitations. But plans to degrade the pauper’s food were also perceived as forcing insipidness onto the nation’s diet. Abolitionist and factory reform firebrand Richard Oastler prophesied that the principle of less eligibility heralded an inevitable lowering of the national fare. “[T]he people of England shall, hereafter, live on a ‘coarser sort of food,’” he bemoaned.[44] The superiority of the nation for Oastler was measured by the quality of food afforded its poorest and most desperate members. Other critics among Chartist circles sensed a plot to render the working classes generally more pliable, with the manager of an inflammatory cheap press, George Edmonds, contrasting the Poor Law’s newly scanty dietary with the gormandizing excesses of the “glutocracy” (those “swinish aristocrats”) who obscenely stuffed themselves in the dining houses of London and Paris. The deprivation of the poor supported the plenty of the rich, in both taste and scale. “[S]tarvation of the poor is benevolently recommended as the sole means of salvation for the rich,” Edmonds wrote, “We are civilized cannibals. We eat each other by law.”[45] The scientific management of national diet was rediscovered in the behavior of the British Government during the Irish Famine — seen by critics as the imposition of Poor Law deterrent principles and grain market exportability upon an entire people. A broad range of protesters therefore recognized the new gastronomic austerity of the workhouse as an attempt to reformulate the ancient terms of social rights and national belonging.[46] And so for the critics, the Poor Law constituted a threat to established notions of social citizenship. “Economy” starved the populace of its national birthrights, even deeply symbolic ones, such as workhouse inmates receiving the traditional Christmas Day repasts of roast beef, plum pudding, and ale.[47]

Permalink for this paragraph0
An intermittently organized “anti-Poor Law” movement occupied an indistinct ground between Chartism and Toryism in the 1830s and 1840s.[48] Radical critics christened model workhouses the “bastiles” of the new economic order, “Mammonitish prisons” for the imprisonment and torture of the poor.[49] Some combined the condemnatory language of Old Corruption with fears of the free market’s atomizing forces. “Test of the Pest House prisons, with all their death-dealing regulations, and horrible accompanying wickedness, is by the orderly poor, more dreaded than any other human infliction,” wrote Samuel Roberts.[50] This reputation was cemented through scandals like that at the Andover Workhouse in 1845-46. There, inmates had been moved by the scantiness of the official dietary to resort to gnawing on the bones the workhouse had contracted to crush into fertilizer with pauper labor.[51] Critics could point to the Andover scandal as evidence that the workhouse system supported a wider system of “out-door” starvation, and coroner courts also periodically confirmed specific cases of deaths by hunger resulting from terror of parochial relief.[52] Criticism of this sort became endemic by the 1860s, with poor metropolitan parishes like Bethnal Green in the heart of the East End achieving particular notoriety for neglect and abuse. Both the Radical and Conservative press casually attributed deaths in the streets there to “the dread the Bethnal-green poor have of their workhouse.”[53]

Permalink for this paragraph0
By the 1860s the London workhouses had cultivated a particularly chilling aura of abuse and degradation. Yet, following the collapse of Chartism the popular indignation of workhouse conditions failed to coalesce into an organized movement that could challenge the eleemosynary severity of the Poor Law. Indeed, some of the most persistent critics of the Poor Law seem to have embraced the absolute separation of private and public poor relief, as well as the core principles of the workhouse test and less eligibility.[54] The ghoulish periodicity of workhouse scandals was increasingly seen as episodic and the fault of individual bad managers, which highlighted specific ameliorations but discouraged systemic criticism. The most prominent reform organization, Louisa Twining’s Workhouse Visiting Society (founded in 1858), for example, provided an arena for the emergence of a cadre of female social reformers but shied from fundamentally questioning workhouse principles of deterrence. As a visitor, Frances Power Cobbe championed genteel oversight and “the Womanly element” as a check to the stingy obstinacy of parochial boards.[55] She and her colleagues chatted with infirm and sick inmates, provided them with “little comforts” like pillows and lozenges, and often drew the enmity of workhouse masters by their mere presence.

Permalink for this paragraph0
Criticism of the workhouse regime, cautious as it was, tended to coalesce around organized efforts to alleviate the plight of sick inmates. Moreover, the sometimes bitter complaints about workhouse austerity only entered public discourse through the agency of middle-class reformers and humanitarians. The voice of the pauper was excluded from respectable discourse. The visitors movement was primarily directed toward alleviating the cruel edges of individual neglect: deficiencies in furniture, dietary, medical attendance, and nursing in sick and infirm wards. In her pamphlet of 1861, The Workhouse as an Hospital, Cobbe found it difficult if not impossible to draw a firm line between “necessaries” and “comforts.” Surely, ratepayers could not expect to be burdened with providing “extraordinary comforts,” but she suggested “necessaries” must include “everything needed for, or conducive to, the recovery of the patients, and everything required to mitigate acute physical suffering.”[56] The anonymous author of a harrowing book about experiences in workhouse visiting, Sick and in Prison, was sardonic toward the Poor Law principles of less eligibility: “Consistency requires that, sick unto death, a pauper dying of fever or consumption, shall not be made too comfortable lest other paupers should go and catch consumption and fevers, on purpose to come and be nursed in a workhouse.”[57] She noticed the “deadly taint” perceptible wherever the sick and aged were crowded together: “the effect of this subtle miasma upon anyone sensitive to such influences is evidently something of blood-poisoning; headache and stupor soon tell their own tale after two or three hours of workhouse visiting, and a delicate person would find it impossible to continue for half that time in the rooms without much suffering.”[58] Clearly, some of these intrepid venturers were shaken by what they saw as needless degradation. “[T]he mass of human suffering, the very monotony of it,” the lady visitor recalls, “seems like a nightmare.”[59] She supposed that sleepless days and nights, miserable food, abusive nursing, and all-too frequent deaths spread horror through the inmates forced to witness these last agonies.

Permalink for this paragraph0
In this environment of criticism, the highly publicized deaths of two London workhouse inmates during the winter of 1864-65 provided the instigation for The Lancet to launch an ambitious survey of the metropolitan “pauper infirmaries” (in reality the sick wards attached to workhouses).[60] Many a workhouse sick ward constituted a veritable “fever nest,” it reported.[61] The internal spread of diseases provided a measure of the institutions’ sanitary state, although filth and impropriety itself was reason enough for disgust. The report repeatedly returned to the rude lack of partitions between seats in common waterclosets.[62] The public was particularly shocked to read that in one workhouse “bedridden patients habitually wash their hands and faces in their chamber utensils.”[63] Singling out, but also using it as an illustration of the general incivility of workhouse infirmaries, the investigators judged the Chelsea itch-ward “the nastiest place altogether that our eyes ever looked upon.”[64] Indeed, they observed sufficient examples of abuse, bad nursing, sickness, filth, insufficient space and ventilation, bad construction, and improper food and medicine to fill the journal’s pages for 18 months and support its denunciation of the London workhouse sick wards as “a disgrace to our civilization.”[65]

Permalink for this paragraph0
The London social reform community directed considerable attention to the interiors of the workhouses in the 1860s and organized around a few notable themes. First, inquiries such as The Lancet’s publicized a mass of sickness and worrisome admixture of ruined respectability alongside dissolute pauperism. The practically novel discussion of the need for workhouse comforts ultimately rested upon a binary view of the inmate population. Twining, for instance, initially took interest in the case of a reduced, respectable old woman confined to a workhouse because of chronic illness. The deprivation of basic comforts horrified Twining,[66] but she was even more appalled at the common accommodations, “where all characters, and vices, are mixed together in one indiscriminate depôt.”[67] Other visitors casually mentioned their conviction that “tea, sago and oranges, and little things” of that sort were pilfered away from their intended recipients as soon as the ladies left the room.[68] For most advocates of reform, the faults of the workhouse came down to a failure to properly classify inmates. Cobbe rallied for the improved and separate treatment of married women, innocent children, elderly, dangerously sick, and miserably insane—all of whom deserved exemption from “the penal elements which belong to the treatment of the idle and vicious pauper.”[69] The fiercely idle, the confirmed prostitutes, and the incorrigible roughs rightly warranted “no superfluities of any kind.”[70]

Permalink for this paragraph0
Secondly, this rhetoric of workhouse classification fed outrage about pauper nursing. Until the 1880s the vast majority of nurses in workhouses were paupers themselves. Dickens’s Sairey Gamp had provided the memorably mischievous icon of the mercenary nurse: any old woman paid to watch the sick, proverbially compensated with beer and gin or, upon her own initiative, stealing the patient’s medicine (in Oliver Twist Dickens depicts them as hideously ugly “hags,” “old crones,” “old harridans”).[71] Pauper nurses achieved an even lower reputation and were a particular concern to Twining, who believed their inherent cruelty required the “constant supervision of superior persons.”[72] Mischievous and incompetent pauper attendants provided a regular source of scandal for the critical and sensational press, [FIGURE 2.1] and the brutality of pauper nurses received special mention in The Lancet survey of London workhouses, which categorically stated that they “are not to be trusted.”[73] Another workhouse critic observed that the male workhouse patients “look far more helpless and more uncomfortable than the women. They miss the care and nursing which only women can give in sickness, and which, poor fellows, some of them may have known in their own homes. Here they nurse each other.”[74] Concerned particularly with improving female attendance, Cobbe condemned the “monster-evil of unqualified nurses”[75] and insisted that all female nurses be of suitable respectability, preferably young and trained, but certainly paid. This was a sketch, in brief, of Florence Nightingale’s program for nursing reform following upon her celebrity in the Crimea and founding of a nurses training school at St. Thomas’s Hospital in 1860.[76] The stereotyped female pauper nurse — epitomizing craggy, worn-out, working-class womanhood and equipped with the authority that allowed her to exercise “terrorism”[77] over others — actually aided the cause of nursing reform. She came to excite a “thrill of horror” in the Victorian mind, practically as pronounced as the figure of the prostitute and just as useful in defining the codes and boundaries proper femininity.[78] One commentator sweepingly condemned the whole breed of female pauper nurses as “Old, infirm, unclean, and often immoral, seldom temperate in any thing, never, as a rule, temperate in drink, idle, careless, utterly inexperienced in all that relates to her appointment, selfish, cruel, and tyrannical, destitute of any religious principle, with not one single qualification for her office, but with every disqualification.” She was “the very last person in the world one would wish to see placed in such a trust;” such persons were “too frequently examples of all that one would most like not to see in any one, and least of all in a woman.”[79]

Permalink for this paragraph0
Thirdly, the issue of workhouse diets remained a constant concern. The New Poor Law required fixed dietaries for workhouse inmates and made little allowance for variation to meet the needs of sick inmates, so that a pauper may have been consistently served a tough crust although they had not a tooth to bite it. Also, often no food was allowed except at statutorily-defined mealtimes, whereas certain sick patients might require nourishment every hour or two. One workhouse visitor explained that “Odd cups of gruel seemed to have the tendency to worry the nurse, perplex the master, and exasperate the Board, so although I constantly saw sick people pining, often nearly sinking for want of some lighter nourishment than hard beef-pie, or strong substantial suet-pudding, it was very unwise to mention it. … [T]hose who know what sickness is, how very much, not only comfort but recovery depends upon patients getting food which they can fancy, the cruelty of this rigid ruling will be best known.”[80] For critics like this, proper nourishment stood close to culinary comfort, which in turn was indistinguishable from effective treatment for sickness. A paper read before the National Association of the Promotion of Social Science recommended allowing workhouse doctors to prescribe suitable diets for individuals as they would with their private patients: “enumerate a group of articles from which the patient may select that which bests meets the whim or taste of the time. How can a sick man derive benefit or comfort from his food when he knows that each day brings him the same quantity of beef or mutton cooked in the same way; no change or variety by which to tempt a feeble appetite?”[81]

Permalink for this paragraph0
For their part, many doctors believed substantive food constituted the best medicine they could provide for their poor and often starving patients (especially food of a “stimulating” sort, such as meat and wine).[82] In this way, medical aid allowed under the New Poor Law reliably exhibited an abrasive relationship to the politically potent issue of food relief. A common rebuttal to the supposed cruel deprivation of the workhouses was that paupers could receive whatever the doctor ordered for them. At the same time, to suppress the supposed liberality of doctors most parishes required medicines to be paid for out of their medical officer’s own salary. Food per se came under different restrictions set by local Boards of Guardians, which often fought hard under the belief that allowing the parish doctor to give his patients anything to cure them would be “an expensive and financially suicidal policy.”[83] Penny-pinching parochial boards tried to frame all food orders by doctors as “medical aid” that they were not obligated to fund apart from the officer’s salary. They were often successful in banning orders for consumables such as beer and champagne, and insisting on tests to determine whether applicants were faking illness in order to receive free stimulants.[84] In most cases, the workhouse doctor was powerless and subordinate to the whims of the workhouse master; his ability to provide sufficient food was “the merest farce with just the shadow of truth in it.”[85] The founder of the Poor Law Medical Officers Association, Joseph Rogers, for instance went through epic battles with his Union board in order to gain control over the dietaries of the Strand Workhouse and was fired from two positions for his temerity.[86] Food assistance occupied a key place in the instrumentality of the Poor Law in sanitary reform (largely as an alternative to the care of the sick). Chris Hamlin shows how Edwin Chadwick, the main ideologue of the New Poor Law, denied that starvation was a significant factor in producing remediable death rates and refuted the medical consensus on links between food scarcities (or more properly, food prices) and epidemic fevers. Doctors had long argued that wholesome, nourishing food was a medical necessity, but the Chadwick gang steadfastly resisted any hint of that concept.[87]

Permalink for this paragraph0
Coarse food — even for the sick — become practically emblematic of the seemingly unshakable Poor Law itself. The Lancet investigators evinced a nuanced criticism for the dietary allowed for sick paupers, citing particular instances of medical officers failing to prescribe extra foodstuffs as medicine. The mainstay of workhouse diets still wanted much attention, especially the beef. In many parishes it “consists of those tough and leathery morsels technically known as ‘clods and stickings’—an unpleasant name for a very unpleasant and indigestible thing.”[88] But they could offer few general indictments of the quality of the dietaries given to sick inmates, except that the nutritive value of meals provided by different boards of guardians varied greatly.[89] Their reticence to condemn infirmary food may be explained by the ingrained notion that little else was expected from pauper establishments. After all, “the paupers seemed very comfortable ‘under the circumstances,’” an article in Dickens’s All the Year Round sarcastically fumed.[90]

Permalink for this paragraph0The Lancet’s methodical exposé of metropolitan workhouses garnered polite outrage, but was given explosive importance by James Greenwood’s infamous literary escapade in the Lambeth Casual Ward (the overnight refuge for vagrants). Writing under the pseudonym, “An Amateur Casual,” Greenwood explained how he had disguised himself as a tramp and infiltrated the mysterious world of the workhouse “to learn by actual experiment how casual paupers are lodged and fed.”[91] “A Night in Workhouse” appeared in the Pall Mall Gazette in early January 1866 and, as Seth Koven has shown, proved a literary sensation with a long-reaching impact in shaping assumptions about the abject conditions of workhouses and the deviant sexuality associated with vagrancy.[92] Serialized over three days, “A Night” was quickly pamphletized, broadsheeted, balladed, reprinted in other newspapers and magazines, and otherwise variously circulated so that, within two months it was reportedly “a narrative all England [had] read and shuddered at.” [93] It inspired a raft of courageous imitations and official inquiries — some of which even mimicked Greenwood’s flare for the incognito, but none that matched his ability to spark the imagination of a public clearly fascinated by the shadowy and repulsive recesses of outcast London.[94]

Permalink for this paragraph0
The tantalizing first installment begins with Greenwood, dressed as a “sly and ruffianly figure,” discretely stepping out of a parked carriage and answering perfunctory questions at the door of the Lambeth workhouse. He is then led to a bath room, where he reluctantly undresses and hastily plunges into a tub already used by several men and filled with a liquid “disgustingly like weak mutton broth.” His story then describes filthy towels, hard bread, lost “skilly,” cold sleeping shed, a jumble of naked men on the floor covered by a single rug each (or worse, “clubbing” together for warmth), vermin, filthy language, and riotous insubordination.[95] Implicitly criticizing a slackardly system of pauper management, Greenwood also paints a compelling portrait of his vicious companions, their threats and acts of violence, sleep-depriving drunken prankishness, and street slang—all of which causes a breathlessly restless night for himself and other “decent men” gathered in the shed. Indeed, Greenwood includes a smattering of unexpectedly sympathetic characters in the casual ward—“honest fellows” who express offense at the language and filth of the “towzled, dirty, villanous … ruffian majority.”[96] For the enthralled public, corrupt language stood in for all sorts of other implied corruptions and tastelessness. But more than anything else, commentary surrounding “A Night” (voluminous in itself) obsessively returned to the horrors of that shared pauper bath. It embodied the visceral grottiness of the workhouse and remained the most memorable element of the story for years.[97] One writer recalled: “Standing in imagination beside the Amateur Casual as he plunged into that bath like weak mutton broth—pah! the flavour of which has not yet passed from our palate, merely from reading about it…”[98] Greenwood’s plunge had united the disparate meanings of “taste;” it distinctly left a sensation on the tongue and materialized the mean indignities of pauperism.[99]

Permalink for this paragraph0
The Amateur Casual sensation also illustrates the contentious epistemology of the workhouse. Skirting the boundaries of respectable prose, Greenwood’s writings flaunted his flaneur-like ability to safely trespass class boundaries but at the same time rested upon his capacity for offense and indignation. Greenwood’s reliability as an eyewitness hinged on his respectability, which in turn was threatened by his overnight ordeal in the workhouse. For his admirers, Greenwood spoke as an outsider testifying from the inside: the hidden eye that lay bare, the gentleman who saw but was not seen. He had eaten the food, splashed in the bath, heard the unguarded conversations of rascally paupers, and in true sensationalist form had lived to tell about it. But Greenwood was foremost a man out of place and not properly belonging to the workhouse. For some, this ruse disqualified him to pass judgment. “[I]t is hardly to be expected,” the British Medical Journal smartly quipped, “that a visitor would find in [casual wards] the elegancies of drawing-room society.”[100] The Rector of Lambeth suggested that “a narrative of a workhouse interior by a man who drives up in a brougham must necessarily be exaggerated.”[101] The metropolitan Poor Law inspector looking into sanitary arrangements at Lambeth workhouse remarked that he did not desire to encourage the Amateur Casual to repeat his dip in the bath, “for that is a matter entirely for his own taste.”[102] Others were more explicit: Greenwood was “some Pall Mall swell”[103] who enjoyed inflicting on the sensitive reader “unnecessary horrors” that “only a man who could go through the mutton-broth bath ordeal would have had the taste to write.”[104] These and others wondered how a gentleman could assess the comforts and necessities of typical paupers. Meanwhile, the unreliability of pauper testimony was practically unquestioned. The Poor Law inspector maintained that “his experience induces him to place no reliance upon pauper evidence or pauper officers.”[105] The Amateur Casual sensation carried on for months partly because of a new spate of deaths and subsequent scandal and inquiry at the Bethnal Green Workhouse (that much-maligned symbol of Poor Law rottenness).[106] The critical press hailed the usefulness of official investigations, but also questioned whether paupers could act as reliable judges of workhouse conditions. The Daily News affirmed the seriousness of charges against metropolitan workhouses, despite what it called the inherent “untrustworthiness of pauper witnesses.”[107] Workhouse inmates continued to be depicted as a troublesome lot who could not provide reliable evidence of their own abjection. Reflecting the ambiguity of their condition, paupers could be simultaneously objects of both sympathy and distrust.

Permalink for this paragraph0
The 1860s were a critical turning point for the London pauper population and its management, in which a new species of guarded compassion for sick paupers challenged the old tone of strict parochial abstemiousness. Attention to pauper infirmaries became a prominent public issue at least in part due to the fact that the London workhouses had become, in the main, huge aggregations of the sick and infirm poor. A precipitous rise in destitution was directly related to the agricultural depression and slack in the industrial regions resulting from the American Civil War. Severe unemployment and malnutrition pooled in the metropolis, fueling the urban entrenchment of typhus fever that lasted most of the rest of the decade.[108] Whilst deliberately uninviting, workhouses nonetheless provided sites of last resort for persons seeking medical assistance—those having an incurable disorder, or lacking the patronage of a charity hospital subscriber, or not demonstrating an “interesting” enough case to draw the attention of hospital physicians. Workhouses provided for the remainder of even less-fortunate patients: lying-in wards for poor women, black wards for venereal diseases, as well as innumerable cramped wards containing a whole range of desperate, hopeless cases that the general hospitals did not want (such as cancer). It was in workhouse infirmaries that a steadily rising proportion of tuberculosis sufferers ended their lives.[109] Furthermore, the London charity hospitals at this time stopped admitting fever and smallpox cases.[110] London workhouse infirmaries now provided primary accommodation for the infectious, incurable, intemperate, and imbecile.[111] In large part, they warehoused the metropolis’ forgotten sick and elderly. Nearly 90 percent of inmates fell into those categories.[112] A survey in 1866 found only 1,850 able-bodied persons out of 23,500 London workhouse inmates.[113] The national workhouse population had fundamentally changed since 1834 — “all this complex plan of accurately adjusted repression, merging so often of necessity into sharpest cruelty, has done its work,” one critic sneered.[114] To all appearances, the “true pauper element” had been smothered,[115] and able-bodied pauperism made “all but extinct.”[116] This was a conclusion cheered by backers of parochial discipline, and yet it also signaled a development that would elicit greater sympathy for the remaining inmates.

Permalink for this paragraph0
Agitation for the reform of metropolitan workhouses moved forward in 1866 amidst a worrying health and political climate.[117] A recrudescence of diphtheria killed many children. Violently periodic typhus outbreaks in the years 1862-65 constantly filled the London Fever Hospital (the charity dedicated to treating infectious fevers). In July of 1866 London’s East End was struck by a disturbing outbreak of cholera just as the riverside shipbuilding industry was collapsing. That summer also witnessed increasingly strident demonstrations and even riots in support of the much-debated and delayed Second Reform Bill.[118] Cholera may have lent special urgency to the activities of the main reform group: the Association for the Improvement of the Infirmaries of Workhouses. These lobbyists — which included The Lancet investigators, several workhouse medical officers and celebrities like Florence Nightingale — noted that indoor pauper sick far outnumbered patients at the charity hospitals. London workhouses were the “real hospitals of the land,” and yet they were almost completely devoid of the treatments and comforts touted by modern hospital medicine.[119] The Association lobbied for centralized control over London pauper sick wards and consolidation of pauper sick into new institutions disconnected from actual workhouses.[120] Critics such as Frances Power Cobbe advocated separate hospitals not on sanitary grounds, but because she found workhouse management “incompatible with proper care of the sick.”[121] Nightingale struck a similarly adamant position in this matter, writing that “So long as a sick man, woman or child is considered administratively to be a pauper, to be repressed and not a fellow creature to be nursed into health, so long will these shameful disclosures have to be made. The sick, infirm, or mad pauper ceases to be a pauper when so afflicted.”[122] Indeed, the punitive treatment of the destitute sick was fast becoming the weakest part of the New Poor Law’s overall ideology of deterrence.[123] One lady visitor cautiously predicted that one day the workhouse sick would be looked upon not as paupers, but as patients: “in the name of Heaven’s mercy let us no longer treat the sick as willfully sick. Surely incapacity and sickness might be made a sufficient test for difference of treatment.”[124]

Permalink for this paragraph0
Some reformers insisted that ratepayers had a civic duty to know how their taxes were expended, and that decent treatment of paupers actually represented the will of ratepayers and electors.[125] It is difficult to assess the extent of sympathy extended to the workhouse sick, but at least some Londoners saw that responsible citizenship was allied with fighting for the humane comforts of the destitute. Charles Dickens, for example, lent his considerable stature to the view that the dismal plight of sick paupers was a measure of society’s health. He incredulously detected “a constantly recurring expansion of conventional wonder that the poor should creep into corners to die rather than fester and rot in such infamous places.”[126]The Times judged the typical London workhouse “a mere receptacle for decaying and dying humanity,” the contents of which accurately mapped the “barbarity” inflicted by modern urban callousness and neglect. This itself was the familiar narrative of the pauper’s abjection:

Permalink for this paragraph0
It is sad to think what these unfortunate creatures may endure without the least interference. Their only fault, perhaps, is that sickness has overtaken them in the heat of their struggle for life. They have fallen out of the ranks and have dropped into the Workhouse hospital, and there all they get is a hard straw bed to die upon, and just food and medicine enough to enable them to die of prolonged suffering instead of mere want.[127]

Permalink for this paragraph0
The frightening combination of disease and destitution overhung intensifying anxieties about the complete collapse of the poor law system in the poverty-entrenched East End. Here, the “vast residuum” of the very poor outstripped the capacity of individual charity. The numbers of paupers and relief expenditures rose by nearly 50 percent between 1865 and 1867, with eastern parishes shouldering the heaviest burden and experiencing much difficulty in collecting the rates.[128] In many minds, the inexorable impoverishment of eastern districts had engendered a noticeable deterioration in the quality of their boards of guardians. This criticism was certainly not limited to the East End, though. The standard London parochial board was characterized as composed of “small tradesmen, chiefly anxious to save the rates, and inclined to every kind of cheese-paring” which would ingratiate themselves to electors.[129] Dickens’s All the Year Round excoriated the “vulgar hucksters who rule our metropolitan parishes,” the “venal, cruel, and ignorant jobbers recklessly torturing the suffering and the helpless.” The typical guardian was “the fellow of coarse mind, low habits, and doubtful honor … the hard, narrow, cruel nature which regards a pauper as an offensive reptile, with a capacity for eating and drinking ‘at this ’ere parish’s expense.’”[130] It is not insignificant that the separation of rich and poor London had burdened eastern parishes with the highest poor rates, while the charge on residents of wealthy districts became relatively light.[131] This perhaps best explains the reputation of East End districts for extremely ungenerous poor relief and mean-spirited vigilance in “protecting the rates.”

Permalink for this paragraph0
The pressure exerted upon parochial institutions by the 1866 cholera outbreak was met with a curious mixture of frantic activity and listless inaction. “Every possible care is taken of the patients” in St. George’s-in-the-East, it was reported. With the aid of local charities, a temporary cholera dispensary provided sherry and champagne to those who could stomach nothing else. Given the alarm of the situation (where 5,000 cases of cholera and diarrhea came under the care of the parish’s medical staff in the first two weeks), the John Bull newspaper observed approvingly, “The guardians are acting liberally under the emergency.”[132] On the other hand, the notorious Bethnal Green drew rebukes for simply cramming all sick petitioners into its already dangerously overcrowded workhouse.[133] In their defense, the Bethnal Green guardians could exasperatingly point to a recent mass refusal of residents to pay the rates. A limit to local taxation had likely been exceeded and the demand upon it was still increasing across eastern and riverside districts.[134] In these areas the duty for relieving a steadily rising number of destitute had to be supported “by ratepayers who are themselves but one step removed from pauperism.”[135] Bethnal Green guardians pleaded for a general reform of metropolitan poor rates, wherein the wealthy districts would help subsidize the needs of struggling parishes. Critics of London’s workhouses generally agreed that improvements for the pauper sick had to take the form of a metropolitan-wide reform of poor law funding, whereby the relatively low rates of wealthy western parishes and the unduly high ones of the East End would be more equalized and the burdens for institutions like pauper hospitals shared from a common fund.[136]

Permalink for this paragraph0
At the same time, cholera also signified significant anxieties about the unruly London mob made more aggressive by recalcitrant pauperism.[137] This can most forcefully be seen in the ideas and activities of the Society for Organising Charity and Repressing Mendicity (better known as the Charity Organisation Society — or COS — founded in 1869), which delivered raspy warnings about “clever paupers” who would always abuse any private charity foolishly expended on them.[138] Striking a very different tone than that of Nightingale and Dickens, these advocates of a harsh and penal Poor Law interpreted the workhouses crisis as a need to shore up the deterrent principles of 1834 and wage a “crusade” against out-relief.[139] According to this view, the typhus fever and cholera crises of the 1860s had prompted a dangerously overgenerous outpouring of charity, which nourished a culture of pauperism and dependence. Sir Charles Trevelyan (infamous architect of the British government’s response to the Irish Famine) provided the typical COS appraisal: “Our lower London population has lost, not only the habit, but the very idea of independent self-support, as well as of the thrift, self-denial, and provision for the future, necessary to maintain it. This is the bitter root of the evils from which we are suffering.”[140] Fearing that a “growing pauper semi-criminal class” had been “secured against starvation,”[141] Trevelyan and his colleagues recommended that individual charity be uncompromisingly limited and that state relief be made more degrading than anything available outside the workhouse. The Rev. J. Llewelyn Davies, a co-founder of the COS, also warned against allowing the pauper infirmaries to become too comfortable. In a key December 1866 Macmillan’s Magazine article, he spoke to the recent spate of workhouse scandals and cautioned against allowing the Poor Law to be “purified and enlarged and softened.”[142] Humane people were naturally “tempted to wish every day that the wards might be made a little more comfortable, the dietary a little more appetizing.” Yet the workhouse must affect deterrence through degradation: “all workhouse improvement, so far as it makes the Poor-law system less repellent, would tend to draw our poor into a kind of life from which they ought to shrink with disgust, and, if it diluted, would also extend, a grievous social malady.”[143] For good measure, Davies also discusses how the pauper infirmaries scandals illustrated the lax maintenance of “less eligibility” principles. Conditions publicized by The Lancet and others were “abuses and cruelties which are simply unequivocal horrors,” Davies observes, but in no case had complaints arisen from the patients themselves. It required outsiders to sense (literally) the offenses. This was perhaps indicative of worse conditions in the sick poor’s own homes.[144] It possibly was also proof of the subjective perception of discomfort and distaste: lack of disgust was an indication of depraved persons, the very definition of paupers as desensitized bodies. And if these subjects were not offended, then where was the offense?

Permalink for this paragraph0
The outcome of these debates — the Metropolitan Poor Act of 1867 — capped years of worried commentary about London pauperism and affected something of a compromise between these competing criticisms of workhouses. An amalgamation of reform and retrenchment, it had something for both the humanitarian and the parsimonious. The Bill’s sponsor, Gathorne Hardy (later the Earl of Cranbrook), explained that “The main object is to classify the inmates.”[145] Accordingly, it established the Metropolitan Asylums Board to manage funds collected from a new Common Metropolitan Poor Rate and to erect and oversee special asylums for the separate accommodation of infectious and the “imbecile” paupers.[146] This reduced disparities in rates for indoor relief between poor law unions across London. It also took responsibility for a large number of paupers out of the hands of the local parishes and (equally importantly) out of workhouses that had been the source of much mischief. Inmates of the new asylums were to receive professional treatment, better medical attention, and more suitable conditions.[147] While regular workhouse paupers, it was stressed, were to be humanely relieved of the presence of these noisome persons, this enhanced classification enabled workhouses to enforce greater internal discipline.[148] Further, while it had been difficult to stomach forcing all applicants into the overcrowded and insanitary institutions, now the workhouses could become a true test of destitution and outdoor relief could be scaled back with a clear conscience. Therefore, the provision for the infectious sick held out the promise of stricter outdoor policies.[149] In this sense, medical classification aided the classification of deservedness. “This is one of those items which cannot be jobbed,” Hardy reasoned.[150] Even more significantly, perhaps, a fever or smallpox hospital repelled the “fictitious sick,” as no one would presumably clamor to enter the infectious environment unless truly needful. More charitably, Hardy voiced the rhetoric of Poor Law reformers in deploring that the harshly deterrent character of workhouses had been applied to the sick, “who are not proper objects for such a system.” Such persons, he insisted, should be shielded from the “evils” arising from workhouse management.[151]In any case, by creating new pauper hospitals the legislation of 1867 fostered the impression of extending a variety of workhouse test to the sick pauper population.

Permalink for this paragraph0
Contrary to the common assumption of following years, the MAB did not originate as a purposive sanitary body. Its primary purpose was not to accommodate the London infectious sick generally. The MAB system that grew from one infectious hospital in 1870 to eleven in 1900 was planned as a safety valve for special workhouse paupers and a specific reaction to the public reputation of metropolitan workhouses.[152] These hospitals were initially tasked with addressing problems of political economy, not public health. This is not to say, however, that “state medicine” at this time could be conceived as separate from management of the poor. The 1871 Royal Sanitary Commission affirmed the need for “an united superintendence and single responsibility for subjects so closely connected as the Public Health and the Relief of sickness and destitution amongst the poor.”[153] The two subjects were “necessarily cognate,” the Commission concluded. “Sanitary laws must bear a constant ratio to Poor laws, the one making provisions for health, while poor laws are necessary for the relief of destitution of which sickness is both cause and effect.”[154] Pauperism was then framed as a substance cognate to the sciences of waste removal. Paupers and excreta were both “human refuse,” both contaminating material constantly sifting to the bottom of society and requiring careful disposal.[155] Mid-Victorian public health primarily meant the provision of sanitary sewerage, clean water supplies and the cleansing of streets. As Nadja Dubach argues, the medicalization of public health took place first through the pauper agencies, although that conflation became increasingly strained and ultimately untenable.[156] Through the 1860s, when it conceited to deal with actual bodies, state medicine was always an issue of destitution relief (or, in the case of prostitutes infected with venereal diseases, as a medico-criminal issue). Bodies subject to the authority of the MAB were initially suitably abject — paupers by definition and by contempt.

Permalink for this paragraph0
In its first years of operation, the MAB found itself accommodating many more persons than simply the conventional pauper class. As explained in Chapter 1, its fever and smallpox asylums immediately became the repository of infectious Londoners from many shades of society. Physicians and public health authorities now placed a great emphasis upon the safe isolation of the sick, and yet no other hospitals were available. Not many Londoners, it also should be noted, would necessarily have known (at least initially) the MAB as a pauper agency. The widespread reluctance to have anything to do with the Poor Law certainly inhibited many from resorting to a public agency like the MAB. But the horror of accommodating contagious diseases at home must also have been decisive in some cases. Smallpox seems to have been a particularly startling disease (especially as it became less endemic and its increasingly rare outbursts that much more terrifying), and one that could induce families to surrender a loved one to the hospital. The severe outbreak of smallpox in 1871 — the worst of the century — was the first time that an emergency situation, fed by panic and shock, caused a sudden inrush to the new rate-supported hospitals. One MAB officer recalled that during the height of the epidemic “every hospital was crammed.”[157] The MAB’s Hampstead Smallpox Hospital in suburban north London opened in December 1870 and immediately felt a great demand upon its space. By August it had received nearly 6,000 patients and the crowding was so great that the staff temporarily resorted to holding two patients in the same bed and housing convalescents in tents and huts on the grounds.[158] Dr. Robert Grieve, Hampstead Hospital’s Medical Superintendent, reported that patients came primarily from “the working classes,” especially whose public work caused them to come into contact with smallpox – “barmaids, shop men and women, ’bus- and cab-drivers, &c.”[159]

Permalink for this paragraph0
Hampstead Hospital was the first architectural manifestation of the metropolitan Poor Law reforms in 1867 and embodied the promises of the new system. The medical profession unconditionally hailed it as the most up-to-date model of sanitary engineering and hospital hygiene.[160] Responsibility for nursing was placed under the guidance of the East Grinstead Sisterhood, a lay Protestant order of women who had provided service in the East End cholera epidemic of 1866.[161]The Illustrated London News prominently depicted these “Sisters of Mercy” in an etching that showcases a ward’s bright, spacious, orderly, tranquil, and moral atmosphere managed by tastefully demure women who epitomize the Nightingale ideal of competent and kindly nursing.[162][FIGURE 2.2] The print, however, provides no suggestion of the already accruing complaints of mismanagement and cruelty. And indeed, the hospital could not escape the mistrust and fear that had so recently been directed at the much-maligned workhouse infirmaries.

Permalink for this paragraph0
Rumors about queer goings-on at Hampstead Hospital circulated for months after its opening and started to be aired in newspapers that summer. One piece of gossip refuted as flatly untrue by the MAB told of a man whose wife was reported dead and whose coffin he thought he had followed to her grave, only for him to be surprised at her return home a fortnight later.[163] A sadly more accurate story was related by a workingman named Henry Walker, who complained of not being informed about his son’s death at Hampstead for over a week after the burial. He wrote to a local newspaper:

Permalink for this paragraph0
I am not surprised at the disease spreading and people hiding cases. I can only say that I have one little boy left, and were he so unfortunate as to take smallpox, neither fear of its spreading, nor force, should tear him from me, let the consequence be what it may. … Little did I think there existed men who forget the common feelings of humanity, or that such a law existed — if such does it exist — as to allow them to bury people without first informing their friends, or you may depend upon it neither my wife nor my boy should have gone there.[164]

Permalink for this paragraph0
Another father’s complaint resulted in a libel suit against The Echo newspaper, which had published the allegation that his daughter returned from the smallpox hospital in a deplorable condition — a “little bag of bones” and nearly blind though neglect.[165] All of these tales resonated with a public already familiar with popular narratives of workhouse abuse, but an important common element involved how these institutions could insult working-class masculine authority as head of household. Another striking story which attracted great attention told of Elizabeth Bellue, a five-year-old child, who went missing from the Hampstead Hospital. The authorities were unable to account in any way to her father, who had called any times and had once been given the wrong child.[166] Again, newspapers presented it as the father’s responsibility to seek redress and to voice other complaints: his other two children were “completely covered with vermin when they came home to me,” he claimed. The magistrate hearing his case shuddered in disgust: “Abominable state of things! I should not have thought it possible in these days in such an institution.”[167] The common criticism in these complaints related to the destabilization and severance of family bonds, which would have been preserved by home treatment. The ugly imputation of pauperism itself, it remained to be said, also threatened the family. To many casual observers, Hampstead Hospital provided hints of being little better than that the parish infirmaries it was meant to supplant.

Permalink for this paragraph0
An explosive series of letters exchanged in The Times in August 1871 seemed to confirm these misgivings. Three recently dismissed Assistant Medical Officers (AMOs) aired allegations of “gross mismanagement” and needless harm to patients. This elicited harshly worded replies from MAB managers and the medical superintendent, Dr. Grieve, who accused the young AMOs of insubordination (as well as consuming massive quantities of Bass Ale and maintaining dogs on the premises for rat-killing competitions).[168] Under pressure, the Government agreed to a public inquiry and quickly empanelled a commission, which eventually sat for 33 days and heard testimony from 115 witnesses. The inquiry, exhaustively reported in several London daily and weekly newspapers as well as medical journals,[169] revealed a hospital that had struggled through nearly a year of sharp pressure upon space, resources and staff. Lawyers representing the former AMOs, however, sought to portray the chaos as directly resulting from mismanagement — itself the result of the Poor Law’s objectionable principles.[170] Importantly, the tone of this inquiry differed from previous workhouse scandals in that former patients were now invited to voice complaints. Testimony by former patients was not dismissed as the disruptive and vulgar sound of paupers. Several former Hampstead patients simply showed up to give testimony after reading about the hearings in the newspapers. Evidence for the defence came from a range of medical staff, MAB officers, current and former nurses, and also some former patients praising conditions in the hospital.

Permalink for this paragraph0
Most former patients painfully recounted a nightmarish environment replete with abusive nursing, repulsive food, dangerously insanitary conditions, and indifferent officials. True, the interior of a smallpox hospital during a raging epidemic must never have been particularly pleasant to its occupants, but complainants made a point of stressing how it had been made worse by official neglect and abuse.[171] The offended former patients often stressed the penal atmosphere of the isolation hospital, and offered a narrative redolent of the emerging genre of personal stories told by persons trapped in “charitable” institutions or wrongly confined in places like lunatic asylums. Another perspective that emerges from their testimony is that of the individual “out-of-place” (no doubt modeled upon the Amateur Casual sensation), where the witnesses testify to the indignities properly reserved for other people but outrageously imposed upon themselves. The unusual scene initially captivated the London reading public. The inquiry provided a startling glimpse into the workings of an institution premised on separation from the outside world. The hospital alternately represented a shadowy nook of officialdom, where medical despots and sadistic nurses enacted the conventional script of a sensational drama, and a stage of pathos, on which the decent poor suffered modern misfortune and navigated the unexpected status of “outcast London.” The Medical Press and Circular commented on the popular interest this inquiry stirred:

Permalink for this paragraph0
It would be easy to underrate, but hardly possible to overestimate, the significance and the importance of this investigation, which, at the onset, forced itself in to the rank of ‘les causes celebes’ of our times. The prodigious impression not in this metropolis alone, nor even England alone, but far and wide over the civilised world, which the opening record of this enquiry produced will not be soon forgotten. Some idea may be formed of the intensity of the emotion, roused by the charges [of the junior medical officers] … from the violent language and violent conduct used by the offended public against the nurses and the Hospital staff. Letters have been received by [hospital officials] frantic in the excess of vituperation and execrative expressions. The public feeling has been deeply stirred. The Government has been appealed to, and the whole press of the country have watched every phasis [sic] and every step of the inquiry with unabated patience.[172]

Permalink for this paragraph0
The Hampstead Hospital scandal contained the conventional elements of sensation fiction and melodrama. Its potential as a truly epic scandal was undermined, however, by the tedium of testimony. The revelations were scandalous, but monotonous and repetitive as well. They were also rigorously challenged, which caused the complaints to be explored in “wearisome detail,” in the words of an evidently bored Times reporter.[173] Interest in the narrative possibilities of the Hampstead Hospital scandal waned over the two months of mind-numbing statistics and detail. The London public became satisfied with condensed summaries of the horrors experienced at the hospital (which, after all, must have been expected from a pauper institution). In any case, the exhaustive testimony from all sides provides a deep and circumscribed archive of how the first great experiment with public hospitalization in 1871 echoed the notorious troubles of the workhouse system.

Permalink for this paragraph0
Nurses bore the brunt of much criticism by former patients. Much of this, in turn, could be attributed to severe under-staffing, as it was not uncommon for one nurse and one Sister to have charge of 40 children in a single ward (and at times as many as 65).[174] The shortage of nurses occasionally left some large wards without supervision,[175] and children reportedly tumbled out of beds on a regular basis.[176] Nurse witnesses claimed it would have been impossible for them to “get on” without strapping down troublesome patients.[177] Much worse, several former patients described dead bodies neglected for scandalously long periods.[178] At least one child died in a ward occupied by only other sick children.[179]

Permalink for this paragraph0
Some of the most resentful testimony came from former patients who had been straightjacketed or pinned with bed linen, ostensibly to prevent their wandering around the ward, falling out of beds, and otherwise injuring themselves or others during periods of frantic delirium. James Henry Wills, a clerk, deposed that during his residency nurses had tied him to the sharp edges of a bedstead, as the marks on his legs still showed.[180] John Channon, a gold and silver plater, testified that in his ward at least 20 patients were wandering in their heads and that their restraint mostly happened at night since the nurses could not cope if there were 3 or 4 of them out of bed at once. Under these circumstances there was “always such a ‘lot of hollering’” and he could not sleep.”[181] While apparently isolated events, they were clearly scandalous for London newspaper readers, who were fascinated by stories of patients suffering under mechanical restraint. This public reaction drew upon elite dread of pauper nursing and plebian narratives of medical villainy. As seen in The Graphic’s fanciful depiction of nurses binding and virtually torturing a helpless patient, the halfpenny press somewhat combined these interpretations. [Figure 2.3] The iconography of such a scene remains, however, rooted in populist narratives typical of cheap melodrama, which could simultaneously warn of the dangers of brawny, empowered working-class womanhood and of the perverse pleasures of high-Church religious extremists (one attendant is obviously an Anglican Sister).

Permalink for this paragraph0
Physical restraint itself did not easily consort with calls for the injection of respectable “feminine element” fostered by Nightingale and the lady visitors movement. It rather called forth the image of unnaturally powerful women dispensing erotically charged and rough treatment (an enigmatic twist on the sadistic scenarios common in pornographic literature).[182] Demonstrating perhaps the extent to which melodramatic conventions structured the public consumption of institutional scandals like this, one of the most eagerly debated speculations surrounding the hospital was the rumor that an Anglican Sister (popularly decried as “popish”) had hurried the missing child Elizabeth Bellue off to a convent to be raised under Catholic rites.[183] Kidnapping young girls by Romanish clergy was a stock-in-trade of the cheap stage. The theme of mechanical restraint, meanwhile, already occupied a thoroughly theatrical place in mainstream Victorian narrative culture, with the straight-waistcoat especially serving as a worrying clue to duplicitous motives (such as wrongful confinement under the lunacy laws[184]). The image of manacling, meanwhile, calls to mind the iconography of abolitionism and the campaign to eradicate shackles and cages from mental asylums.[185] Tales of human bondage added a melodramatic flare to the Hampstead revelations, with patients equating their treatment as paupers to that of slaves, convicts and lunatics. Mechanical fetters also had to be framed as essentially undomestic; it was a relic of institutional treatment that might be expected from strangers, so different from the moral management proper to the home.

Permalink for this paragraph0
Much of the actual care of the sick at the Hampstead Smallpox Hospital was performed by patients themselves — a fact which itself was also cause for much complaint. At any one time, most inmates were convalescent: they were through the worst and most dangerous part of the disease but not well enough or free of infection to leave. These patients were required to help the nurses in the ward-work, such as emptying slops and commodes, sweeping floors, making beds, and the like. Of course, work had long been required from able-bodied workhouse paupers. As patients graduated to the convalescent wards they could expect extra rations of beer and meat in return for their labor and could wear little stars to distinguish them.[186] Yet smallpox was particularly gruesome. James Henry Wills related that he refused to help lay out the body of a fresh corpse because it was in “such an offensive condition.”[187] Several former patients recalled that they willingly and happily did what they were asked.[188] But other inmates risked being disciplined as refractory paupers when they refused to perform certain tasks. Arthur Partridge, a bootmaker, complained at the inquiry that his beer was cut off when he declined to assist in scrubbing a ward.[189] In these and other ways, the hospital exactly resembled a workhouse (which it legally was) and conformed to the shame-inducing pauper regime.

Permalink for this paragraph0
Unsurprisingly, criticism of nursing at Hampstead Hospital solidified around the tired stereotype of the pauper nurse. This makes even more sense when we consider that perhaps the majority of paid nurses were recruited from the ranks of former patients. (They were also hired as groundskeepers, porters, charwomen, laundry attendants, and others). Administrators had an enormously difficult time attracting persons from outside to take up what everyone recognized as hard work in an exceptionally unpleasant environment. The chairman of the Hampstead Hospital committee testified to having “exhausted every means of getting nurses, often in vain, even though we were offering the most liberal wages.”[190] One former patient, Elizabeth Haynes, returned to the Hampstead Hospital as a nurse following her discharge and was employed there for a few months. She admitted to tying children to their beds even when they were not delirious, since she struggled to both scrub the floors and continually bring drinks to patients who called out.[191] Despite being former inmates, these nurses received little sympathy from their patients, who saw them as the true paupers. As described by George Tidbury, a tailor, the ward nurses fairly often approximated the clichéd Sairy Gamp, getting drunk on the “stimulants” of patients too ill to complain.[192] A young patient declared that a nurse called “Frisky” shook her fist and vaguely threatened him with punishment.[193] (The patients apparently considered nurse Fisk—or Frisky—as literally mad.[194]) There may have been little actual social difference between patients and nurses, yet a gulf was evidently perceived. The nurses commanded an unwarranted position of grave authority and several patients chaffed under the incongruity which, they claimed, gave rise to petty tyrannies.[195] Albert Emerson Denton, a solicitor’s clerk, complained that the nurses “had them completely in their power, and patients were punished by them for complaining.”[196] Others told of not complaining because they feared of being “served out” by the spiteful nurses, such as having their rations reduced.[197] Little comforts became the currency of negotiation between patients and nurses. Elizabeth Fowle, described as the wife of a watchmaker, complained that a spat with Nurse Meredith resulted in her beer being stopped.[198]

Permalink for this paragraph0
A whole species of complaints from former patients related to the Hampstead Hospital’s cleanliness and sanitation. One witness felt insulted by being required to share 4 or 5 towels among 113 patients.[199] Another common grumble claimed the linen was persistently bug-ridden.[200] Some of the more shocking allegations included persons seriously infested with vermin— lice on heads, maggots in wounds, and the like.[201] In response, the MAB witnesses suggested that dirty paupers were invariably affected with “nits” before coming to the hospital (“some good specimens of the creatures could be seen any night in the casual wards,” one remarked[202]). But others maintained that only a small proportion of the hospital population had any previous experience with such pests and that blame for vermin lay upon mismanagement and lack of treatment. One of the AMO complainants, Albert Kynaston, estimated that 8 or 10 out of every 12 admittances did not harbor vermin.[203] Lice, therefore, was used as a rough measure of true pauperism. The breakdown of laundry facilities caused a lack of clean sheets and clothes, meting out another stigmatizing sign of destitution. Edward Wilson, a chairmaker, claimed that upon admission to the hospital he had “served out to him a ‘lady’s nightgown’ for a shirt,” and he “made shift” with it for some time.[204] Some patients were placed in beds directly after another left. William Charles Peters testified that “the bed allotted to him was in such a disgusting condition, from the sheets being defiled with ‘gore, matter, and lice,’ that he preferred walking about all night to sleeping in it.”[205] Elizabeth Fowle, the watchmaker’s wife, stated that her dress was not changed nearly often enough, and when she was transferred to a convalescent ward after the death of her child, her dress was “stiff up to her arms with filth.” She also recalled disgusting tubs of water almost black with the filth of previous washers (disturbingly reminiscent of the “Amateur Casual’s” notorious bath five years earlier).[206] Testimony of filth and vermin effectively captures former patients’ sense of transgression and dangerous intermixture. They were, like James Greenwood, persons out of place; but unlike in his escapade, they unwillingly masqueraded as paupers.

Permalink for this paragraph0
Former patients complained most persistently — and most emphatically — about the poor quality of the Hampstead Hospital diet. Unappetizing and indigestible they claimed, the food forced patients to taste the debasement of the workhouse and perform the abjection of the common pauper. Numerous individual objections stand out. It was “impossible to distinguish the tea from the coffee.”[207] The potatoes were usually bad, moldy or spotty (patients used to joke that the “taturs” had the smallpox like the patients).[208] The butter was “rank”[209] and, one witness asserted, “he would not grease a cartwheel with it.”[210] While still in hospital, several patients had signed a petition to Dr. Grieve regarding the tea, coffee, meat and short measure of beer. They testified that the dietary improved shortly, but soon fell back into its bad state.[211] Miserable food clearly resonated with the penalty meted out with the infamous pauper gruel, yet some patients challenged the food’s suitability under even Poor Law standards. James Henry Wills, a clerk, very deliberately said that he thought the food was “vile” and “not fit for paupers” (persons he evidently thought far below his station). He had “what was called boiled mutton handed to him on an ice cold plate, and potatoes not fit for a pig.”[212] This theme of inhuman consumption drew a parallel upon the indignities of pauper consumption. The petition sent to Dr. Grieve contained a statement that the meals were not fit for a dog, and not enough for a dog.[213] And indeed, comments of this sort marked practically every session of the inquiry, with former patients seemingly very eager to devise ever more evocative culinary condemnations as a means of spurning the pauper taint.

Permalink for this paragraph0
Meat repeatedly served as a potent symbol of the Hospital’s daily institutional fare, which left patients hungry, uncomfortable, and reduced in dignity. Many patients traced its disagreeableness to a lack of care in preparation, which itself was resonant with pauperism —interminably boiled and unseasoned, either repeatedly inferior beef or repeatedly low-grade mutton. One patient swore they could not tell the difference by how they tasted.[214] Another witness deposed that the meat, though over boiled, could not be boiled tender,[215] while others grumbled that the nurses and officers received roasted meat, whereas the patients only got boiled.[216] Some believed the fare was good in quality but always badly cooked. A butcher, Thomas Owen, remembered the meat “stewed as if the goodness was stewed out of it.” The plate-meat also contained “stickings” — inferior parts of the carcass fit for making beef-tea but which should not be served themselves.[217] For others though, the offensiveness of the meat also involved suspicions about inferior sourcing. Denton, the solicitor’s clerk, could not identify what part of the sheep the meat came from, for he had “never seen such a joint before. … It was a third lean, a third fat, and had a like quantity of bones.”[218] Meat could apparently convey a sense of degradation like few other foodstuffs. A variety of witnesses, almost entirely men, rained down abuse on the tough, coarse, indigestible meat,[219] with more than a few remembering meat on occasion that was “distinctly decomposing.”[220] Once, 14 patients refused to consume their dinner until the medical officer had seen the meat.[221] A bootmaker, Arthur Partridge, however, claimed to have sometimes opened a window and thrown the disappointing stuff out.[222] The relative absence of fleshy viands had long marked the deprivation and degradation of the pauper meal, yet its presence in an offensive form could convey that ignominy just the same.

Permalink for this paragraph0
Several male patients pointedly insisted that the “very middling meat” was “unfit for sick men.”[223] Chris Otter writes of how meat consumption was strongly gendered within Victorian patterns of consumption and representation.[224] The pauper regime at Hampstead Hospital was therefore also an insult to the manly culture of meat-eating and the chops of British citizenship. William Charles Peters, described as a wine and commission agent, stated that he did not admire Parisian beef, “yet he would say that French beef was better than Hampstead beef” (evidently a cosmopolitan yet also very damning patriotic assessment).[225] Patients like Elizabeth Fowle, the watchmaker’s wife, were also insulted by the degraded domesticity of the hospital and had grown indignant at bad meat. It was “served out in coarse and vulgar-looking pieces; it was like cats’-meat,” she testified. Perhaps cognizant that this was a typically masculine complaint, Fowle added quite emphatically that they were “certainly not ‘ladylike-looking’ pieces.”[226] The vulgarity of pauperism was baked into this coarse fare, but it was a humiliation that could be differently expressed by men and women patients. The variety of complaints about the meat is one indication that this was an important public means of asserting self-respect and, at the same time, bringing the complex politics of private consumption into what was intended to be a highly normalizing institution.

Permalink for this paragraph0
In addition to (and perhaps in spite of) the distasteful rations, patient after patient also deprecated the small portions allowed by the hospital authorities. Many ruefully assumed it was part of the “starvation diet” allowed paupers by the Poor Law Board. John Channon related a strange mixture of repulsion and attraction, as there were always hungry patients ready to snatch what others had left on plates in disgust.[227] Another witness concurred that there were “always plenty of candidates to eat it,” since no one could get enough; patients got “about four good mouthfuls [of meat], and if more was supplied it was an accident.”[228] Convalescent patients often had ravenous appetites. Michael Croakes, a 15 year-old son of a master tailor, stated that when he got better he could have eaten four times as much as was given him.[229] Several former patients, all men, deposed that they received far less than the official dietary’s stipulated 6 ounces of meat. Thomas Johnstone, a machine maker, drew laughter from the court when he estimated his average cut of meat at about 16th of an inch thick.[230] The butcher, Thomas Owen complained directly to his AMO that he was doing pretty well in the hospital, except that he was “nearly starved,” to which Greaves replied that it was out of his power to give more to eat. Receiving food from outside was apparently against the rules, but Owen wrote to his relatives and had them send parcels of bacon, cheese, cakes, biscuits, anchovies, “and cetera.” He testified to frizzling the bacon in the ward during the doctors’ rounds expressly to show that there was not enough to eat, and this reportedly became the “talk of the hospital.”[231] Disobedience of this sort and the somewhat embellished nature of complaints serve to emphasize the perceived inappropriateness of workhouse discipline for sick persons. The patients consistently sought to stress how out-of-place they felt.

Permalink for this paragraph0
Patients pined for the aromas of homely comforts — specifically, those requisite invalid foods such as beef-tea, arrowroot, and milk. Peters, the wine agent who did not like French roasts, said he could not “make out” the beef-tea and accounted for its bad taste by the rumor that it was made from Liebig’s meat extract (an imported South American condensed beef jelly).[232] In home-nursing, the preparation of beef-tea was an honored craft of domestic womanly attentiveness to invalids and was supposed to derive from actual joints of meat solemnly stewed into thick broth on the hob. [233] The hospital, however, provided the Victorian version of cheap, industrially-processed “slop.” John Aikman, one of the complaining AMOs, found the beef-tea from extract “was fearfully salt, and had a really abominable taste.”[234] Decent milk and arrowroot (traditional sick-food) were also scarce and dearly missed, patients presumed because due to workhouse restrictions on wholesome victuals. Each drink held a place in the habitus of sickness and therefore also carried the burden of representing social respect. Henry William Clicker, a foreigner tailor, claimed he did not get enough milk. He did testify to having been offered water, but amused the court in stating he “never drank water in his life.”[235] These preferences should not be overlooked as mere petulant grumbling (although they are certainly that too). The Hampstead patients were deliberately asserting their claims as sick persons and the domestic comforts that could be expected of that class. These they placed before and against what they saw as their superficial and artificial — yet official — status as paupers.

Permalink for this paragraph0
Scanty food provisions for patients formed part of the original complaints to The Times that had launched the inquiry. Albert Kynaston, one of the dismissed medical officers, explained that during his casual visits the wards “would be like a Babel, from a lot asking for food at once.”[236] He and his fellow junior colleagues testified to their persistent inability to get the amount of eggs, milk and wine they deemed necessary for the recovery of specific patients — a malprovision they traced to the hospital’s Poor Law status.[237] For its first six months, until June 1871, the Hampstead Hospital operated under emergency powers granted by the Poor Law Board, meaning that the institution had not received orders governing its conduct. With the managers cautioned against being extravagant, Dr. Grieve drew up three standard patient dietaries: low, ordinary and full.[238] Many patients complained of being kept on the “low” diet and noted the paucity of the “ordinary” diet. Apparently Dr. Grieve did not authorize full diet at any time, though he justified this as a medical measure in smallpox treatment.[239] The distribution of the austere dietary was even more rigorously enforced after the hospital received its Poor Law orders in June, with Dr. Grieve now reserving the right to nullify food prescriptions given by the junior officers. Kynaston testified that up to that time he could order port, sherry, brandy, whisky, extra bread, milk and beef tea,[240] but henceforth, it was stipulated (as in all workhouses) no “extravagances” would be tolerated.[241] The AMOs had great difficulty in getting the one item they previously could prescribe in abundance: eggs. Dr. Grieve described the increased expenditure on this item as absurd, extravagant, even ridiculous.[242] Kynatson testified that when he was ill in the hospital he had to pay for eggs and wine out of his own pocket, as the Board disallowed these items to be provided from the public purse.[243] This official dietary could be undermined by patient practices. A patient confessed that he could trade postage stamps for milk — indicating something of an authority-defying underground barter within the hospital.[244] Still, the AMOs bravely cast the patients’ standard ungenerous dietary in medical terms. Having been forbidden by Dr. Greive to intervene in any matters not strictly “medical,”[245] the junior officers nonetheless maintained that treatment in smallpox was essentially a question of diet and comfort.[246] So, while ample food was considered a luxury under the Poor Law, the ward-level doctors saw it as a key therapeutic necessity. They went so far as to argue that the high mortality amongst child patients could be traced to insufficient nursing and nourishment — Kynaston heatedly argued with Dr. Greive that deaths in the hospital would be halved if the dietary (principally milk) were doubled.[247]

Permalink for this paragraph0
The patients’’ complaints tended to link the issues of sustenance and taste, and they thereby provide a glimpse upon the precariously traversed terrain of pauper undeservedness. Thomas Jones, the mechanical draughtsman, testified to only taking the beef-tea once: “he never tasted such a cup of nastiness in his life.”[248] During his deposition, legal counsel representing the MAB elicited an admission from Jones that he had entered the hospital “on the parish” (St. Pancras) and had not reimbursed the parochial authorities for his costs of maintenance. He was therefore in reality a pauper in a legal and moral sense, the attorney maintained. Jones retorted that he was in the hospital through having smallpox, but the attorney pointed out that others had paid, and suggested that non-payers like Jones had less ground from which to voice complaints.[249] And indeed, the MAB’s attorneys rather vigorously indicted the testimony of James George Palmer (the man who could not distinguish the beef from the mutton) by tracking him after his hospital discharge. They showed Palmer had immediately visited the Newport Market Refuge for the Destitute and received clothes from this homeless charity.[250] The implication was clear: paupers cannot legitimately talk about taste or judge discomforts.

Permalink for this paragraph0
But paying patients — to the extent that this distinction means anything — complained in much the same manner. One patient sent from Islington parish, Edward Beuyon, a draper’s assistant, did later pay for his keep and “was, therefore, not a pauper,” The Times account made sure to note. For this reason the inquiry may have attached more weight to his complaints, reportedly delivered “quietly and in an unexaggerated manner.” They were nonetheless practically indistinguishable from those of the others: the meat was “like Gutta percha” and little in quantity; the butter was “very bad;” it usually took an hour to have a dead body removed from the ward, even when it would stink very much; the bath was filthy and the wards infested with loathsome vermin, etc.[251] Beuyon’s testimony serves as a reminder that “pauperism” was for isolated smallpox patients an arbitrary designation, and one that practically all inmates of Hampstead Hospital would have rejected.

Permalink for this paragraph0
Testimony of former patients was strongly colored by recognition that the hospital imposed pauperism upon them, and much of their grief can be traced to their desperate desire to escape this fact. The restrictions on postage stamps, for example, caused much humiliation and caused many to see the hospital as a penal environment. Officials justified the opening of patient’s letters as a precaution to prevent the spread of infection through surreptitiously exchanged money or stamps, but Poor Law rules also stipulated that paupers were not entitled to any possessions.[252] Dr. Grieve said he feared servants being bribed. Thomas Jones, the St. Pancras man who had been sent “on the parish,” testified that Dr. Grieve claimed he was obliged to see that nothing came in, “for he was a pauper”:

Permalink for this paragraph0
I told Dr. Grieve that I wanted to know under what authority he opened my letters, and he asked me what I thought I was. I told him I was a draughtsman, that was what I was, and I would see when I got out all about it. He told me I was a refractory pauper. It was the general feeling in the ward that it was no use to complain to Dr. Grieve.[253]

Permalink for this paragraph0
Many complainers perceived their civil status tainted by uncivil treatment. Several agreed with the bricklayer, Charles M’Laren, who testified that he was told not to complain because “while he was there, he was only a pauper.”[254] Others related that they held their tongues in the hospital because they believed paupers were liable to imprisonment for misbehavior like complaining.[255] Michael Croakes, a 15 year-old son of a master tailor, deposed to his inability to get milk when he needed it. When asked why he did not complain to the hospital officials, Croake related a story about the wardsman, Mr. Gee. This official took a patient off to “the cells” and said he would feed him bones for dinner (a vague reference to the Andover Workhouse scandal?). That ruse reportedly kept Croake from complaining to anyone, even the priest who made rounds in the hospital, for fear of being placed in the hospital dungeon.[256] Sarah Daly, a nurse, testified however that Croake had been a “dirty boy” and could not be trusted as to his statements about not getting milk from her — “when he came in his head was afflicted [with lice], and his hair was cut off.”[257] In many ways, therefore, hospitalization as a pauper could be taken as tantamount to imprisonment.

Permalink for this paragraph0
For all the complaining, it must be recognized that patients could not escape the utility of the hospital and they subsequently displayed complex attitudes toward their confinement. For example, Barter, the bank clerk who talked in detail of the revolting sanitary state and unpalatable food, also pleaded with Dr. Grieve to be allowed to stay a few additional days after being cleared for discharge because his father had expressed fear of infection.[258] Many of the ex-patient nurses were servants by occupation who would have had difficulty finding employment directly after being released for smallpox, and so they accepted hospital employment.[259] Similarly, the waiter, Thomas Hatcher, who had also complained bitterly to the inquiry about food and vermin, also stayed longer than he needed to because “with the marks on my face I could not get work, and I stayed to get rid of the marks.”[260] This, however, also served as another source of complaint, with some former patients remarking that they received no specific treatment for the boils and lesions peculiar to smallpox (which could leave permanent scars). The pauper hospital could not have taken responsibility for the aesthetic aspects of disease management. Instead, nurses were more likely to cut off patients’ hair in order to control the “nits” that plagued the hospital — a drastic measure in any other circumstance and one that was also visually stigmatizing. The inquiry commissioners steered away from exploring the issue, as they considered treatment a matter of medical control, but patients sought to portray it as an issue of general mismanagement and shortage of nurses. Edward Beuyon testified that he never saw the nurses wash a patient, nor did they attend to the offensive skin discharges. He had seen the nurses cut patients’ hair but not apply oil or treatment to the heads to actually eradicate the lice and maggots.[261]

Permalink for this paragraph0
The workhouse hospital was in fact responsible primarily for segregation of dangerously infected persons — not their treatment and cure. This provided a rough advantage for patients seeking to maintain a refuge while they were (at least temporarily) physically impaired, as was the case for James George Palmer, the man exposed by MAB attorneys as essentially homeless following his hospital stay. He expressed significant anxiety at the idea of going out before his face had healed.[262] His predicament highlights the sad fact that shabby appearance could be an irretraceable step toward unemployability and actual destitution. Palmer and others cannot easily be categorized as irascible paupers who grumble for the pleasure of complaining (although hospital defenders attempted to do just that). Rather, the thorny acceptance of hospitalization by patients like him shows that there existed a newly fluid and frighteningly unpredictable boundary between ordinary sickness and the most stigmatizing performances of pauperism.

Permalink for this paragraph0
The ambiguity of this divide can be seen when considering the witnesses who testified for the MAB and presented a very different version of events. Inquiry commissioners were very interested to hear exculpatory testimony from administrators, nurses, porters, stewards, and other employees, as well as contented former patients. For their part, hospital officials stressed the emergency situation under which the Hampstead Hospital struggled for months. They also offered unabashed praise for the goodness of meat, beef-tea, potatoes, bread, butter, and milk. Mary Manning, a nurse from the opening of the hospital and not a former patient, insisted there was always plenty of everything and patients never left food on their plates.[263] The contractor supplying meat swore that its quality was exactly the same as supplied to private customers and was “fit for any gentleman’s table.”[264] Other nurses testified that delirious patients were tied down for their own safety, and they were released as soon as possible.[265] A number of former patients offered their gratitude, such as Masoah Walker, a former patient now employed as the hospital’s coachman, who swore that “everything was done in the hospital for the comfort of the patients.”[266] Exonerating testimony of this sort from hospital employees may have appeared to some as self-serving. But despite this, The Lancet, which had proved its reforming zeal in the previous wave of workhouse scandals and could claim much credit in bringing about the establishment of the Hampstead Hospital, strongly praised the management of Hampstead Hospital.[267] All of the main medical journals took a similar line, and spent more time censoring the behavior of the junior medical officers who had brought complaints to the public. Dr. John Murray, visiting physician to the Middlesex Hospital, typified the response of the medical establishment in a report where he described the charges brought against the Hampstead Hospital as “childish and exaggerated.”[268]

Permalink for this paragraph0
With plainly contradictory testimony in play, assessments of conditions at Hampstead Hospital turned upon estimates of the character of the witnesses. James Salmon, a cabman described in The Times as a “respectable man of his class,” was called by the MAB attorneys to state under oath that there was sufficient and good food and patients had “no cause whatever for complaining of anything.” He further claimed that the dirty habits of the patients themselves contributed to the sometimes “sloppy state” of bathrooms and other parts of the hospital.[269] The MAB’s procession of grateful working-class witnesses claimed that their modest appetites and tastes were satisfied. Stephen Wakefield, for example, testified that he could earn 24 shillings per week as a bricklayer’s laborer; the food in the hospital “was quite as good as he got out of doors, and as good as a working man could wish for.” Charles Alderson, described as “a respectable man of the artisan class,” stated that the bread and beer were especially good, the latter much better than could be had in publichouses.[270] This set of witnesses drew upon a different type of domestic metaphors than the complainers, usually embracing the paternal (or more accurately, maternal) care of the hospital authorities. A Mrs. Swann of Islington testified that her child came out of Hampstead Hospital with a perfect “corporation” [sic]; the boy had “far better treatment and nursing than he could have had at home.”[271] Flowers Allpress, a master saddler, maintained that he could not have been more kindly or better attended to at the hospital if he had been a child cared for by its mother. He blamed all discontent on a “dirty lot — the kind of men one saw at publichouse corners.”[272]

Permalink for this paragraph0
MAB attorneys called upon some key stereotypes of pauperism to support their characterization of the complainers as unreliable. A series of parish officers were asked to describe the smutty domestic situations of specific patients who had delivered damaging evidence. The Islington parochial relieving officer did so, and then gave his general opinion that persons in his parish who had contracted smallpox were familiar with vermin, “exceedingly dirty, and lived in an overcrowded state.”[273] His fellow officers concurred that persons sent to the hospital from rich districts — some of them gentlemen’s servants “used to good living” — had not complained about their treatment.[274] Miss Harrison, a Hampstead nurse who The Times describes as having the “manners and speech of a well-cultured person,” reasoned that “this hospital was one of the places provided for those who could not be treated in their own homes when smitten with this disease; it followed that there were many brutal, blasphemous, and violent persons in the wards at times.”[275] This was the dominant explanatory narrative proposed by MAB defenders at the inquiry: that complainers suffered from disordered domesticity, coarse manners, and typical pauper ingratitude. The patients were an indolent, incorrigible, malcontented lot for whom all charity, and even state aid, was in fact undeserved.

Permalink for this paragraph0
The Hampstead Hospital scandal slipped from newspaper pages in the late autumn of 1871, and little notice was taken of the official report of the inquiry delivered in January 1872. It was predictably dismissive of the charges brought against the hospital’s senior management, even making a point of regretting that complaints by former patients had been “based upon such slight and insufficient grounds.”[276] Echoing this official response, The Lancet was delighted to characterize the allegations as “so flimsy and exaggerated in character that they ought never to have been made.”[277]

Permalink for this paragraph0
The public narrative that emerged from the anti-climactic scandal was fragmented and diffuse. Most London observers undoubtedly obtained a vague confirmation of the horrors of London workhouses, especially when allowed the unpleasant addition of loathsome illness. Yet middle-class newspapers (even those of a strongly reformist bent) also tended to foreground the fact that this was a pauper hospital. Subsequent commentary noticed that the majority of inmates had been paupers in title only. The Morning Post typified this molding of the scandal’s meaning when it concluded: “not one of these complainants was of the pauper class.” It added, quite conjecturally, that true paupers “not only did not grumble at their fare, but expressed themselves as highly delighted with the luxury in which they had been maintained.”[278] Those who complained, in other words, had successfully shown themselves to be not paupers.

Permalink for this paragraph0
The public nature of the scandal allowed Hampstead patients to confirm a narrative of persons out-of-place: they were patients, not paupers. In this regard, the bitterness and disgust with which they denounced the institutional arrangements was crucial. The domestic failures of the institution allowed a “sensibility for discomfort” to re-center thought upon the proper appetites and regulated tastes of the respectable poor and lower-middle classes. Moreover, if recognition of foul food and filth in the workhouse served to produce a contrast between these patients and ordinary paupers, it did little to advance a criticism of workhouse settings per se. This reflection meant that the scandal tended to undercut discussion of absolute conditions, as if taste and comfort was indeed a subjective appraisal that primarily reflected one’s social station. Food, the most emotionally potent example, was brought back into the orbit of relational assessment — precisely the tenor of much of the patients’ complaints. These persons out-of-place were therefore disqualified them from judging proper pauper treatment. The Lancet recalled that the inquiry “showed very many well-to-do people coming forward as witnesses about tough meat and other things which real paupers would hardly have cared much, or as much, about.”[279] The experiences of true paupers, the Morning Post ventured, “had made them less sensitive to the unpleasantness of dirt than people whose organisations have not been blunted by the casual wards.”[280] This unveiled reference to the lessons of the “Night in a Workhouse” scandal illustrates how that previous scandal continued to mold subsequent revelations about workhouses’ disordered domesticity. The Medical Times and Gazette reasoned that the average treatment at Hampstead Hospital could not “suit the requirements of persons who had been accustomed to the comforts with which the lower middle-classes surround themselves in this country. The Hospital may have been fairly good for a pauper Hospital, but it was not suited for the reception of patients of various grades of society.”[281] The accommodation of “non-paupers” amidst “true paupers” allowed the London press to place the meaning of the scandal amidst a host of equivocations, all of them based upon the persistent fiction that there existed a real distinction between these two groups. The Hampstead Hospital row therefore confirmed the degradation of pauperism.

Permalink for this paragraph0
The lesson that most took from the scandal was an awareness that non-paupers should not be accommodated amongst paupers. The Medical Times and Gazette concluded that the system of metropolitan isolation which “classes paupers and decent clerks and tradesmen together in the same wards — making them use the same linen and towels, and undergo the same hardships and indignities — is manifestly a mistake.”[282] It primarily had in mind a concern for the effects upon public health if an association with pauperism indelibly stained the sanitary hospitals. Even the Morning Post, decisive in praising the “triumphant acquittal” of the MAB in the Hampstead Hospital case, admitted that most patients had been admitted “not in charity to themselves, but in order to prevent their infecting others.”[283] The Borough of Marylebone Mercury worried that unpleasant revelations at Hampstead driving the public from hospitals altogether “would be the greatest public calamity. The isolation of infectious diseases is a necessary sanitary precaution for the welfare of the state.”[284] The inquiry had begun as a deposition upon the “rottenness of the poor-law arrangements,” which had made “harsh and even cruel treatment” common to workhouses. It ended by raising even more questions regarding the evident contradiction of managing health through the pauper agency. As the Mercury editorialist continued, there were always limits to state charity: “we cannot call upon ratepayers to provide extra comforts.”[285] Yet this was precisely the issue that introduced a protracted debate about persons pauperised by the public health: “Those who are removed from their homes for the good of others on sanitary grounds to hospitals should have secured for them efficient medical attendance, food and nursing, and not be subject to horrors of uncleanliness worse than that expected by the amateur casual.”[286]

Permalink for this paragraph0
The Hampstead Hospital scandal, placed within the context of debates about workhouse conditions, reveals that multiple strategies of tasting marked debates over the Poor Law. Within this discourse of deprivation and degradation, taste became a register by which to place persons or explain their misplacement. For their part, “paupers” were not passive entities, nor were sick patients who never considered themselves paupers in the first place. Material comforts and standards of domestic care played a powerful role in staking claim to social respectability and civil status. In this sense, the MAB’s new system of isolation hospitals could not escape protest and complaint. Its position within the Poor Law system guaranteed that infectious disease control would be seeped in the politics of “coarser food” (and indeed the pauper penalty altogether). The terrifying reputation of London workhouses shadowed the early history of the MAB and conferred a taint that was difficult to remove.

Permalink for this paragraph0[3] It concluded that the reduction in the scope of the feast from the previous year was evidence of the superiority of the Free Trade party and the resulting expansion of cheap food. Morning Chronicle, 27 December 1851.

Permalink for this paragraph0[8] Pierre Bourdieu, Distinction: A Social Critique of the Judgment of Taste, translated by Richard Nice (Cambridge: Harvard UP, 1984), 6.

Permalink for this paragraph0[9] Taking cue from the work of Norbert Elias, a host of scholars have considered civility occurring between the literal and the ideational. One of the more obvious, but slippery, connections between the two registers of “tatse” comes in the form of food and food practices. Priscilla Parkhurst Ferguson, “The Senses of Taste,” American Historical Review 116/2 (April 2011), 371-84.

Permalink for this paragraph0[10] Schivelbusch, Tastes of Paradise, . This suggests that preferences in the act of consuming foodstuffs have a complicated but ultimately only tangential relationship to the biochemical and cognitive acts of registering flavour.

Permalink for this paragraph0[20] This piece of parochial cruelty actually emerged under the Anatomy Act of 1832, which Richardson describes as a dress-rehearsal for the principles of 1834. Wide segments of the public interpreted anatomization as a dishonorable dismemberment and sacrilegious violence upon the dead, a fate traditionally reserved as an additional punishment for the worst condemned criminals. Dissection of paupers after death, according to Ruth Richardson’s classic work, is reflective of a change in attitudes toward poverty and need, but also toward wealth and its privileges. Richardson, Death, Dissection and the Destitute, 2nd Edition (University of Chicago Press, 2000 [1987]). See also Hurren…

Permalink for this paragraph0[22] Dickens’s Little Dorritt – horror at being seen in company of the workhouse pauper on temporary leave. … The Marylebone Guardians were accused of condoning infanticide when in 1861 they moved to require lying-in cases at the workhouse to wear “the repulsive pauper clothing.” The Morning Chronicle was outraged, and predicted that abolishing the privilege of their own clothes (plainly meant to deter them from coming to the workhouse) would compel women “through a most painful process of humiliation” and incline them toward terminating their pregnancies or their newborns, Morning Chronicle, 12 February 1861.

Permalink for this paragraph0[25] Anne Digby, Pauper Palaces (Boston: Routledge, 1978); M. A. Crowther, The Workhouse System, 1834-1929: The History of an English Social Institution (Athens, GA: University of Georgia Press, 1981). We should also consider the protests of the abject subject. “The lonely figure of the pauper” (Polyani) must be joined with the community of paupers. A growing historical literature recognizes them not as passive actors, but as agents who often took an active role in challenging the rollback of their legal rights. Paupers sowed havoc against hated workhouse masters and matrons, or otherwise subverted the disciplinary designs of the workhouse system. See David Englander, “From thr Abyss: Pauper Petitions and Correspondence in Victorian London,” London Journal 25/1 (2000), 71-83; David R. Green, “Pauper Protests: Power and Resistance in Nineteenth-Century London Workhouses,” Social History 31/2 (May 2006), 137-59; Murdoch, Holland Lees,. … As seen forcefully in the works of Charles Dickens, the stigma accorded to paupers could be turned on its head as a tool for trenchant social critique (although this was almost always a conservative technique, warning of misplaced degradation and persons improperly associated with the lowest sorts; Oliver Twist, the pauper hero, it turns out, is actually heir to a distinguished pedigree).

Permalink for this paragraph0[26] Megan Doolittle, “Fatherhood and Family Shame: Masculinity, Welfare and the Workhouse in Late Nineteenth-Century England,” in The Politics of Domestic Authority in Britain since 1800, edited by Lucy Leap, Ben Griffin and Abigail Wills (New York: Palgrave Macmillan, 2009), 84-108. etc..

Permalink for this paragraph0[35] Charles Dickens, Oliver Twist, or The Parish Boy’s Progress (New York: Penguin Books, 2002), 13-14, 53; L. Smith, S. J. Thornton, J. Reinarz, and A. N. Williams, “Please, Sir, I Want Some More,” British Medical Journal (17 December 2008). The strict dietaries issued by the Poor Law Board came amidst a lengthy document detailing minute procedures of admission, chains of command, responsibilities of officers, and forms of punishment for disorderly and refractory paupers. Discipline and diet were typically addressed in the same section of the orders – including also the governance of mealtimes, their location, intervals, signaling of commencement and of durations (by bell), and content. The seven classes of paupers had a specific dietary table ordinary assigned to them, each with exact amounts, the Orders even stipulating a procedure for the weighing of portions by the mater or matron of the House. “Fermented or spirituous liquors” were disallowed unless ordered by the Medical Officer. Poor Law Commissioners, Workhouse Rules… to the Guardians of the Poor of the Several Unions and of the Parishes under a Board of Guardians, named in the Schedule hereunto annexed, and the Officers of such Unions and Parishes (5 February 1842).

Permalink for this paragraph0[36]The Slang Dictionary: or The Vulgar Words, Street Phrases, and ‘Fast’ Expressions of High and Low Society (London: John Camden Hotten, 1870), 232

Permalink for this paragraph0[39] John Coveney, Food, Morals and Meaning: The Pleasure and Anxiety of Eating, second edition (New York: Routledge, 2006), 65-75.

Permalink for this paragraph0[40] Ellen H. [Swallow] Richards, The Cost of Food: A Study in Dietaries, 2nd Edition (New York: John Wiley and Sons, 1913), 60-61. Richards continues: “There are several other reasons why conclusions are more valuable in such cases. The inmates have little chance of getting food from outside. They are usually under the eye of the physician. The raw food material is of standard quality, of which the analyses are more numerous, and therefore more to be relied upon. It is limited in variety, purchased by contract, and the amounts served are more definitely known. This is in cases where there is no fraud, and where the cooking is skillfully and consciously done—which is, alas, not always the case.” (61) For an example of the anecdotal and speculative nature of food science outside the institutions, see Richard Baron Howard, An Inquiry into the Morbid Effects of Deficiency of Food (London: Simpkin, Marshal & Co., 1839).

Permalink for this paragraph0[45] George Edmond, Appeal to the Labourers of England, an Exposure of Aristocrat Spies and the Infernal Machinery of the Poor Law Murder Bill… (London: S. Wilson, [1836]), 10, 12. See also Roberts… 14.

Permalink for this paragraph0[46] Peter Gurney, “‘Rejoicing in Potatoes’: The Politics of Consumption in England during the ‘Hungry Forties,’” Past and Present 203 (2009), 99-136.

Permalink for this paragraph0[52] “A New Chamber of Horrors,” All the Year Round, 2 March 1861, 500-501; Morning Post, 16 January 1867, 7; “Another Charge of Workhouse Neglect,” PMG, 19 September 1866.

Permalink for this paragraph0[53]John Bull, 20 January 1866, 40-1. See also Bell’s Life in London and Sporting Chronicle, 31 October 1863, 2; Morning Post, 2 May 1864, 4; The Standard, 29 March, 1866, 2.

Permalink for this paragraph0[54] Henry Sidgewick traces this to the “wide theoretical acceptance” of John Stuart Mill’s argument in his Political Economy. Aschrott, English Poor Law System, vi.

Permalink for this paragraph0[56] Frances Power Cobbe, The Workhouse as an Hospital (London: Emily Faithful & Co., 1861), 3. Unlike at the great London medical charities, workhouses rigorously suppressed the drugs really needed, “the more expensive anodynes and tonics, cod-liver oil, bark, steel, and sedatives.” (6) Power Cobbe relates the case of a Board who hired a surgeon and introduced this reform, despite his salary being less than half of what the board previously paid in medicines. Nor could the notorious pauper gruel meet the needs of the sick. Where beef was allowed, Power Cobbe, noted, it was boiled and therefore unsuitable for aged and infirm persons. Hard planks which were suitable beds for temporary paupers were “utterly unfit for the poor creatures compelled to spend in them months, and perhaps years, of pain.” (4-5)

Permalink for this paragraph0[70] Frances Power Cobbe, “The Philosophy of the Poor-Laws and the Report of the Committee on Poor Relief,” Fraser’s Magazine, v.70 (September 1864), 374. The subtlety of this approach was expressed by Lord Lyttleton, who in moving adoption of the Society’s 1860 Annual Report, “expressed his strong opinion that workhouses should not be made attractive, and that the condition of the paupers therein should not be made more enviable than that of the poor without. He had, however, great pleasure in supporting the society.” The English Woman’s Journal (June 1860), 275.

Permalink for this paragraph0[72] Twining, Workhouses and Women’s Work, 13; Twining, “Workhouses,” in Transactions of the National Association for the Promotion of Social Science, 1857 (London, 1858), 572. See also Sick and in Prison.

Permalink for this paragraph0[73]Lancet, 18 November 1865, 576.They were “mostly a very inferior set of women; the males, who are ‘nursed’ by male paupers, are yet worse off… [this being] a peculiarly rough, ignorant, and uncouth set.” Lancet 29 January 1865, 132. The Bethnal Green workhouse employed forty pauper nurses “whose tendencies to drink cannot be controlled.” Lancet, 27 January 1866, 105. Inevitably “the patients do not respect them,” the investigators explained, which meant “that in the great majority of cases pauper nurses can only manage their patients by inspiring fear, and that their conduct is consequently often brutal.” Lancet, 1 July 1865, 19.

Permalink for this paragraph0[76] Pauper infirmaries were among the first institutional targets of the nascent movement for nursing professionalization (both “lady nurses” and the subordinate “trained nurses”). The first graduates of Nightingale’s system found employment at the Liverpool Workhouse infirmary in 1865.

Permalink for this paragraph0[78] As Alison Bashford and others show, the new nursing model carefully negotiated gender stereotypes and turned them to new ends. Alison Bashford, Purity and Pollution: Gender, Embodiment, and Victorian Medicine (New York: St. Martin’s Press, 1998), esp. chapter 2, “Female Bodies at Work: Narratives of the ‘Old’ Nurse and the ‘New’ Nurse,” 21-39; Mary Poovey, “A Housewifely Woman: The Social Construction of Florence Nightingale,” in Uneven Developments: The Ideological Work of Gender in Mid-Victorian England (U Chicago Press, 1988), 164-201.

Permalink for this paragraph0[79] Alfred Meadows, “On Hospital and Workhouse Nursing,” in The Church and the World: Essays on Questions of the Day, edited by Rev. Orby Shipley (London, 1866), 119, 124-25.

Permalink for this paragraph0[81] Samuel W. North, “What Means ought to be adopted for Improving the Management of Workhouses?” Transactions of the National Association for the Promotion of Social Science, Manchester Meeting, 1866 (London, 1867).

Permalink for this paragraph0[84] M. W. Flinn, “Medical Services under the New Poor Law,” in The New Poor Law in the Nineteenth Century, edited by Derek Fraser (New York: St. Martin’s, 1976), 45-66.

Permalink for this paragraph0[85]Sick and in Prison, 21. See also Samuel W. North, “What Means ought to be adopted for Improving the Management of Workhouses?” Transactions of the National Association for the Promotion of Social Science, Manchester Meeting, 1866 (London, 1867).

Permalink for this paragraph0[87] Christopher Hamlin, “Edwin Chadwick, ‘Mutton Medicine,’ and the Fever Question,” Bulletin of the History of Medicine 70/2 (1996), 233-65; Christopher Hamlin, Public Health and Social Justice in the Age of Chadwick (NY: Cambridge UP, 1998), 90-102.

Permalink for this paragraph0[90] “In Praise of a Rotten Board,” All the Year Round, 20 October 1866, 343. It is also true that workhouse “sick diet,” while not up to the standards provided in the charity hospitals, may have surpassed that available to the sick poor in their own homes.

Permalink for this paragraph0[91] Anthologized in Peter Keating, ed. Into Unknown England, 1866-1913: Selections from the Social Explorers (Manchester UP, 1976), 33-54.

Permalink for this paragraph0[92] Seth Koven, “Workhouse Nights: Homelessness, Homosexuality, and Cross-Class Masquerades,” in Slumming: Sexual and Social Politics in Victorian London (Princeton UP, 2004), 25-87.

Permalink for this paragraph0[93] J. C. Parkinson, “A Real Casual on Casual Wards,” Temple Bar, v. 16 (March 1866), 498. A New York newspaper was able to state that it had been consumed “by this time, wherever the English language has penetrated.” The Round Table, 17 March 1866, 165.

Permalink for this paragraph0[94]The Observer sponsored a four-part series of midnight visits to London workhouses and a pre-arranged tour of the originally offending casual ward by the Rector of Lambeth. Koven, Slumming, 26, 46-51.

Permalink for this paragraph0[95] Koven stresses the “homoerotic dimensions” contained in the story, especially the numerous references to naked men and boys “clubbing” their beds together to keep warm, the striptease nature of the narrative, and Greenwood’s vague allusions to improprieties that could not be printed. Koven, “Workhouse Nights.”

Permalink for this paragraph0[96] “A Night in a Workhouse,” Into Unknown England, 38, 40. Greenwood, in a later essay expounded upon the divergence: “Take the number of applicants for temporary workhouse shelter at sixty, in all probability at least half of that number will be worthless wretches, cadgers by birth and breeding, and with habits and minds as foul as the rags that hang about their bodies, and possessed of a devilish desire to contaminate and drag to their own bestial level every human creature that mischance throws in their way.” As for the decent man forced by hunger and need to associate with this milieu: “It is as though, in pretend compassion for a man lame of limb, you carried him to a hospital and laid him for cure amongst patients stricken with deadly fever.” Greenwood, “Mr. Bumble and his Enemy ‘The Casual,’” in The Wilds of London, 359-60.

Permalink for this paragraph0[98] A Templar, The Gladstone Government; being Cabinet Pictures (London, 1869), 322. The author here goes on to state that he associated the memory of the bath with the advent of the young Pall Mall Gazette as a preeminent London newspaper. “[I]n emersing [sic] himself in that revolting liquid,” Greenwood had rendered it “among our organs of public opinion.”

Permalink for this paragraph0[99] Promiscuously bathing paupers viscerally linked ablution to alimentation (which also suggests that taste and flavor, long used as a marker of civility, also featured alongside the discourse sanitary reformers produced on the connection of filth to smell and sight). Revulsion of the mouth is called upon to legitimate the transgression of pauper degradation. Disgust over the common tub represents how hygiene had already become imbricated in assessments of tastefulness. And so “A Night” was richly sensorial in its symbolism, further linking workhouses and apposite middle-class disgust. The tingly feeling induced by the narrative made it practically the journalistic equivalent to the age’s immensely popular sensation novels (those which were famously “preaching to the nerves instead of judgment,” according to one critic). The success of “A Night” demonstrated the commensurability of slum reporting with sensation novels. Scandals such as those enveloping the Lambeth workhouse, as well as the daily copy of penny papers, successfully exploited the depths of decadence—especially if revolting delicate senses, and even more especially if featuring villains who, because of their depravity, could not experience the same reactions of disgust. It was said of Greenwood that he “leads the upper classes into a new land—a land perhaps which they will never have either the wish or the opportunity to explore for themselves.” Review of Greenwood’s In Strange Company, London Society, v.25 (January, 1874), 95. Greenwood’s primary mode of writing conformed to this convention of repulsive attraction, plumbing the myriad horrible fascinations of London’s slums, sewers, and dens of infamy. Curiosities of Savage Life (1864), The Wilds of London (1874), and Low Life Deeps (1876) were among Greenwood’s books that lent an ethnographic-exploratory tone to his urban trawls and that compiled a gross catalog of social difference.

Permalink for this paragraph0[101] “Terra Incognita,” John Bull, 20 January 1866, 40. A Lambeth guardian objected that “it was easy for a man who rode up in his carriage to contrast his style of living unfavourably with that of the poor.” Bell’s Life in London and Sporting Chronicle, 20 January 1866, 10.

Permalink for this paragraph0[102] “The Treatment of the Sick Poor in Bethnal-Green Workhouse,” The Standard, 18 January 1866, 6. The first installment appeared on a Friday, the next day Farnall visited. Every Saturday, 10 February 1866, 149. — & Times???

Permalink for this paragraph0[104]Fun, 27 January 1866, 192. This same article faults the attention Greenwood pays in his story to the brougham that took him to the workhouse and picked him up afterwards. The carriage was “in bad taste—it was as if the writer had not been accustomed to a brougham, less accustomed to that than a casual ward almost, from the importance he gave to it.” (ibid.)

Permalink for this paragraph0[106] The Pall Mall Gazette accused the Bethnal Green guardians of manslaughter, and renewed its assertions that parochial authorities had proved themselves uniformly unfit for their important tasks. As for the workhouse management itself, there was “something absolutely revolting” in the neglect that put the power of life and death in the hands of pauper nurses. And therefore a crucial element in these condemnations involved the impression that workhouse officials did not really have control in the institution, confounding the moral distinction between paupers and their watchers. “Bethnal-Green Workhouse,” Pall Mall Gazette, 12 January 1866. Amplifying public outrage, the Bethnal Green Guardians reacted with insubordination to the Poor Law Board’s instructions to remediate conditions. Bell’s Life in London and Sporting Chronicle, 7 April 1866, 3.

Permalink for this paragraph0[107]Daily News, 19 January 1866. Similarly, coroner courts that publicized the state of pauper corpses (like Fellowes and Scully) yielded more reliable evidence than pauper voices. The investigatory mode favored was the outside official, preferably the medical witness such as in The Lancet inquiry, which could secure confidence by projecting both respectability and objectivity. One social reform journal recognized the public notoriety garnered by Greenwood’s story, but found The Lancet revelations “free from favour … thoroughly competent and independent…, [and] trustworthy and disinterested.” [The Charities Record, 30 November 1867, 50. This source, though, gets it backward in placing Greenwood’s salacious story prior to the commencement of The Lancet’s investigation.]

Permalink for this paragraph0[109] Arthur Newsholme, “An Inquiry into the Principle Causes of the Reduction in the Death-Rate from Phthisis During the Last Forty Years, With Special Reference to the Segregation of Phthisical Patients in General Institutions,” Journal of Hygiene 6 (1906), 304-384.

Permalink for this paragraph0[116] Samuel W. North, “What Means ought to be adopted for Improving the Management of Workhouses?” Transactions of the National Association for the Promotion of Social Science, Manchester Meeting, 1866 (London, 1867), 632. We should place this observation in context with fact that the 1834 Law had “singled out the male able-bodied laborer as a target of hostility” and stripped him of all rights to comfortable parish relief as a means of forcing him back into the labor force. Consequently, parochial aid went disproportionately to women, children, elderly, and sick. Lynn Hollen Lees, “Survival of the Unfit: Welfare Policies and Family Maintenance in Nineteenth-Century London,” in The Uses of Charity: The Poor on Relief in the nineteenth-Century Metropolis, edited by Peter Mandler (Philadelphia: University of Pennsylvania Press, 1990), 74-76.

Permalink for this paragraph0[117] The Webbs mention fears of epidemic disease in their history of metropolitan poor law reform, but remain vague about their exact relevance. See Sidney and Beatrice Webb, English Poor Law History, Part II: The Last Hundred Years, v.I, in the English Local Government series, v.8 (Archon Books, 1963), 316-17.

Permalink for this paragraph0[118] The epidemic that had been anticipated for months finally broke in July and eventually killed nearly 4,000 Londoners (mostly in the East End) before petering out in November. [See William Luckin, “The Final Catastrophe: Cholera in London, 1866,” Medical History 21 (1977), 32-42.] The appearance of cholera coincided in July with a large Reform League demonstration in which the Hyde Park railings were damaged and a huge mass of protesters confronted a detachment of Horse guards on the park. The affair created a palpable fear among the “governing classes” about “an incipient alliance between the ‘casual residuum’ and the ‘respectable working class’.” Gareth Stedman Jones, Outcast London (Oxford, 1971), 241-42.

Permalink for this paragraph0[122] Quoted in Ayers, 9. The Times agreed, editorializing that persons finding themselves in the workhouse for no other reason than disease were “distinct and separable from pauperism” and therefore they should be removed and treated differently. Times, 6 March 1866, 9.

Permalink for this paragraph0[123] David Green, “Medical Relief and the New Poor Law in London,” in Health Care and Poor Relief in 18th and 19th Century Northern Europe, edited by Ole Peter Grell, Andrew Cunningham and Robert Jütte (Burlington, VT: Ashgate, 2002), 220-45.

Permalink for this paragraph0[125] Frances Power Cobbe, The Workhouse as an Hospital (London: Emily Faithful & Co., 1861), 2; “A Night in a London Workhouse,” in Curiosities of Street Literature (London: Reeves and Turner, 1871), 137.

Permalink for this paragraph0[129] Ernest Hart, “The Condition of Our State Hospitals,” Fortnightly Review, v.3 (1865), 221. See also Times, 5 March 1866, 7 and the comments of Shirley F. Murphy, former St Pancras MOH, about the preponderance of slumlords among his late employers in First Report of Her Majesty’s Commission for Inquiring into the Housing of the Working Classes, 1885. The Lancet, in surveying the composition of St Margaret’s and St John’s, Westminster, noted that only about 15 “gentlemen guardians” could be found among its 57 members. These men took very little role in the proceedings, leaving the active part of the board to individuals listed in the Post Office Directory as Butcher, Pawnbroker, Cheesemonger, News-agent, Grocer, Baker, Potato-salesman, Publican, and others. Lancet, 7 April 1866, 376. David Owen characterizes the tradesmen class which dominated the local boards as “mean and penny-pinching.” Owen, The Government of Victorian London, 1855-1889: The Metropolitan Board of Works, the Vestries, and the City Corporation (Cambridge, MA: Harvard University Press, 1982), 38. See also Stedman Jones, Outcast London, 248-49.

Permalink for this paragraph0[132]John Bull, 11 August 1866, 541-42. At least 600-700 glasses of brandy were prescribed each day, about 200 of which were given to out-door cases (i.e., those receiving parochial aid but not residing in the workhouse)… Certainly over the objections of horrified teetotalers who questioned alcohol as a medicine and others who considered it always fatal to the workhouse test.

Permalink for this paragraph0[133]John Bull, 11 August 1866, 541-42. The overcrowding prompted the parish to buy a temporary iron building from the London Fever Hospital (which had been used there during the Typhus outbreak).

Permalink for this paragraph0[138] The COS program of “rational almsgiving” meant the scientific management of alms in order to train the poor to better habits of thrift and self-reliance. In theory, this centered on disallowing aid to benefit the undeserving. In practice, it meant extending the tight-fistedness of the Poor Law to all areas of private charity, while reserving the harshness of the workhouse for all those who could not abide by the new terms. The COS’s extremist re-assertion of self-reliance principles disparaged all state assistance to those who had unwisely failed to prepare for adversity. It also attempted, as many others had already done, to draw a firm mental line between society’s unfortunates (victims of old age or illness who could legitimately resort to organized private charity) and the true pauper element (whose vicious characteristics would be more properly repressed in the workhouse system). Most famously, the COS program devised tests of deservedness and established rosters of aid recipients with a central clearinghouse of information on families and individuals, their circumstances and personal histories of charitable receipt. The self-consciously pragmatic ideology of the COS proved to be immensely influential in social work, modern bureaucratic record-keeping, quantitative social research, and case management. It rose, however, out of a firm ideological reassertion of classical political economy during a time when liberalism was otherwise losing its love for laissez-faire. Charles Loch Mowat, The Charity Organisation Society, 1869-1913: Its Ideas and Work (London: Methuen, 1961); Robert Humphries, Sin, Organized Charity and the Poor Law in Victorian England (New York: St Martin’s, 1995); J. W. Mason, “Thomas Mackay: The Anti-Socialist Philosophy of the Charity Organisation Society,” in Essays in Anti-Labour History: Responses to the Rise of Labour in Britain, edited by Kennith D. Brown (London: Macmillan, 1974), 290-316.

Permalink for this paragraph0[139] The “crusade against outrelief” was directed against parochial assistance provided outside the workhouse doors (e.g., “out-door relief”). Proponents argued that the workhouse test needed to be enforced in every case as a means of suppressing pauperism. A sudden drop in pauper rolls in the 1870s corresponds with this campaign, although this is certainly no accurate measure of decline in destitution itself. Mary MacKinnon, “English Poor Law Policy and the Crusade Against Outrelief,” Journal of Economic History XLVII (1987): 603-625; Elizabeth Hurren, Protesting about Pauperism: Poverty, Politics and Poor Relief in Late-Victorian England, 1870-1900 (Boydell Press, 2007).

Permalink for this paragraph0[140] Sir Charles Trevelyan, Letters to The Times and Lancet on Famine Fever and Public Charities (London, 1873), 4. As Assistant Secretary at the Treasury, Trevelyan authored the Northecote-Trevelyan reforms of the civil service. A recent book has tried to rehabilitate his image in regard to the Irish Famine. Robin Haines, Charles Trevelyan and the Great Irish Famine (Dublin: Four Courts Press, 2004).

Permalink for this paragraph0[146] Infectious persons were simply understood as sufferers of “fever and smallpox.” According to the Act, the insane inmates accommodated by the MAB “shall be such harmless persons of the chronic or imbecilic class as could lawfully be detained in a workhouse. No dangerous or curable person such as would under the statutes in that behalf require to be sent to a lunatic asylum shall be admitted.”

Permalink for this paragraph0[147] The Act also provided for consolidated infirmaries for the sick generally, but this almost immediately constricted into a more modest reform. The grand repositories for the non-contagious infirm and sick did not materialize (except one at Highgate). The MAB alone survived as a long-term functioning operator of consolidated sick asylums.

Permalink for this paragraph0[148] Green, Pauper Capital, 236-37; Aschrott, The English Poor Law System, Past and Present (1888), 73. The 1867 Act also made more uniform the practices and standards of metropolitan parishes and Unions, many of which had operated under private Acts and had escaped central control since 1834.

Permalink for this paragraph0[149] Indoor relief was taken from the Common Fund, but outdoor relief was still the responsibility of local parishes and unions—maintaining a clear incentive to reduce the latter. Unsurprisingly, after 1867 expenditure on London workhouses was dominated by sick and insane ward construction. Driver, Power and Pauperism, 89.

Permalink for this paragraph0[154]Second Report of the Royal Sanitary Commission, Cmd.281 (London: HMSO, 1871), 32. In wake of this report, the Local Government Board was formed, regulating nationwide sanitation and poor relief: “two distinct though correlative departments.” (32) In reality, the Poor Law Board was renamed the Local Government Board and given the additional portfolio for sanitation and public health legislation. Parochial government, in the words of M. W. Flinn, had already proved “a tempting peg on which to hang further administrative functions,” especially in regards to health. In 1840 free vaccination was provided through the Poor Law. The 1846 Nuisance Removal and Diseases Prevention Act made local guardians responsible for clearing nuisances and controlling epidemics. The Nuisances Removal Act of 1855 passed these duties to vestries, but in rural areas at least they returned to parishes within a decade. The 1872 Public Health Act implemented the ideas of the Royal Sanitary Commission about local Poor Law responsibility for public health. M. W. Flinn, “Medical Services under the New Poor Law,” in The New Poor Law in the Nineteenth Century, edited by Derek Fraser (New York: St. Martin’s, 1976), 51-53.

Permalink for this paragraph0[155] W. Graham, “Some Aspects of Pauperism in Relation to Public Health,” Public Health v. 3 n.38 (June 1891), 423-27. A number of studies have stressed this symbolic relation in the early Victorian period between sanitary reform and the abject poor generally. Chadwick, for instance, clearly saw sanitation as a measure primarily useful for repressing pauperism. See Gertrude Himmelarb, The Idea of Poverty: England in the Industrial Age (NY: Knopf, 1984), 357-59; Christpher Hamlin, Public Health and Social Justice in the Age of Chadwick (NY: Cambridge UP, 1998).

Permalink for this paragraph0[157] Alexander Collie, RCFSH, 139. Nearly 25,000 patients passed through the MAB hospitals during that epidemic year, yet some estimated that cases of home-treated smallpox reached over 20,000 in London alone. Some 9,643 metropolitan deaths were registered as smallpox in 1871-72, with 3,020 occurring in hospitals. RCFSH, xiv.

Permalink for this paragraph0[158] The number of patients at Hampstead rapidly increased. Starting December with 120 beds, the hospital went to 190 by early January, 258 on 9 February, 292 on 12 February, 326 on 17 February, 360 on 22 February, 394 on 25 February, and to 414 directly after. By May, the Hampstead Hospital held 514 patients in all stages of the diseases. Times, 12 October 1871, 11.

Permalink for this paragraph0[159] Dr. [Robert?] Grieve, “An Analysis of 800 Cases of Smallpox Observed during the Present Epidemic in the Hampstead Small-Pox Hospital,” Lancet, 18 March 1871, 372. See also “Dr Ballard on the Health of Islington, MTG, 6 May 1871, 519.

Permalink for this paragraph0[160] The wards were designed to be provisional, as it was planned they would be regularly torn down and replaced as the materials became saturated with infection. “The Hampstead Fever Hospital,” Lancet, 29 January 1870, 173-74.

Permalink for this paragraph0[161] Sisters – Paid nurses – helped out by convalescent patients. The Sisters were paid, since the Poor Law Board did not allow for unpaid services in its establishments, but this money went to the Sisterhood at East Grinstead instead of the Sisters themselves. Times, 7 October 1871, 11.

Permalink for this paragraph0[162] Because of its wide circulation, this etching has made its way into a number of histories (including one important medical history text) as purportedly illustrative of a mid-Victorian ward interior influenced by the teachings of Nightingale. The image is reproduced in W. F. Bynum, et. al., eds., The Western Medical Tradition, 1800-2000 (New York: Cambridge University Press, 2006), 193 and Ronald Pearsall, Night’s Black Angels: The Forms and Faces of Victorian Cruelty (New York: David McKay Co., 1975), 86.

Permalink for this paragraph0[169] The Hampstead scandal was covered in The Times, The Lancet, The Medical Times and Gazette, The Echo, The Standard, Lloyd’s Weekly Newspaper, The Daily News, The Morning Post, The Illustrated Police News, and undoubtedly many more.

Permalink for this paragraph0[170] The inquiry took on the appearance of a legal proceeding. The interests of the MAB and the former AMOs were defended by attorneys who conducted cross-examinations of witnesses as in an actual trial. (In fact, on day __ of the hearings, when the medical officers declared they could no longer afford to secure counsel, the Government stepped in to cover the “prosecution’s” costs in order to maintain an atmosphere of fairness and unbiased inquiry.)

Permalink for this paragraph0[171] Smallpox patients would normally spend two to six weeks in hospital—provided they did not die (mortality from smallpox hovered around 18%).

Permalink for this paragraph0[174]MTG, 30 Sept 1871, 421. In other wards at one time there were 3 nurses for 49 children. MTG, 30 Sept 1871, 422. When the epidemic was really raging, up to 65 children in one ward with two nurses. MTG, 14 Oct 1871, 477.

Permalink for this paragraph0[181]Times, 26 September 1871, 9; IPN, 30 September 1871. Medical witnesses debated the potential harm of mechanical restraint, but agreed that it should only be ordered and supervised by attending physicians. One physician had taught in his lectures that restraint in smallpox tended to turn slightly delirious patients frantic. According to witnesses, nurses restrained patients on their own initiative, essentially hiding the practice from physicians who objected to the practice — which prompted one of the AMOs to complain that problems such as these existed because the hospital contained only “half-trained” nurses. IPN, 30 September 1871; MTG, 30 Sept 1871, 421, 422; MTG, 14 Oct 1871, 478. IPN, 14 October 1871; Henry Drake Palmer, Times, 7 October 1871, 11.

Permalink for this paragraph0[184] Peter McCandless, Liberty and Lunacy: The Victorians and Wrongful Confinement,” Journal of Social History 11/3 (Spring 1978), 366-86.

Permalink for this paragraph0[185] A powerful discourse of “non-restraint” derived from decades of development of “moral treatment” at English mental asylums. Elaine Showalter, The Female Malady: Women, Madness, and English Culture, 1830-1980 (Penguin, 1985); Akihito Suzuki, “The Politics and Ideology of Non-Restraint: the Case of the Hanwell Asylum,” Medical History 39 (1995), 1-17.

Permalink for this paragraph0[188] Complicating the narrative of abusive nurses, convalescents allegedly performed much of the “tying down” of delirious patients. John Hunter, Times, 22 September, 1871, 9.

Permalink for this paragraph0[190] William Henry Wyatt, Times, 13 October 1871, 9. The Sisters of Mercy performed almost entirely supervisory roles; others were needed to carry out the “grunt” work of the wards. Nurses trained on the Nightingale model were yet few and probably repelled from smallpox nursing like everyone else.

Permalink for this paragraph0[195] Kate Black, a former patient described by The Times reporter as a “respectable ladylike young woman” from suburban Kilburn, complained to the inquiry of the unkindness of the nurses. On one occasion, a woman who was very ill “begged the nurse … to be kind to her, for her time was not long in this world, and the reply made by the nurse was, ‘No, old girl, you will be off by the morning.’ The nurse who said this was Price, and the women spoken of did die in the morning.” Times, 6 October 1871, 9.

Permalink for this paragraph0[201]MTG, 30 Sept 1871, 419. Patients unaffectionately called the lice “speckled backs” or “Hampstead donkeys”—and it was said that nearly all the patients in an infested ward acquired them. Thomas Jones, Times, 3 October 1871, 9; Elizabeth Fowle, Times, 4 October 1871, 11. Parents also protested that their children’s heads upon return home were “encrusted” with sores, filth and pests. MTG, 30 Sept 1871, 423.

Permalink for this paragraph0[206]MTG, 7 Oct 1871, 452; Times, 4 October 1871, 11. The inquiry heard other undeniable echoes of Greenwood’s infamous story. The convalescent wards, for example, were described as “huts” like the sleeping quarters at Lambeth Workhouse. They were little better than “cowsheds,” where “the wind came in sufficient to blow one’s hair off his head.” George Tidbury, Times, 5 October 1871, 11. They were “only fit for cattle.” Edward Beuyon, Times, 5 October 1871, 11.

Permalink for this paragraph0[233]Oliver Twist provides a deliberately striking contrast between properly-prepared sick food and pauper gruel: Mrs Bedwin prepares “a basin full of broth strong enough to furnish an ample dinner, when reduced to the regulation strength, for three hundred and fifty paupers, at the very lowest computation.” “[B]etween slops, and broth well compounded, there existed no affinity or connexion whatsoever.” (p. 90, 93)

Permalink for this paragraph0[251] Times, 5 October 1871, 11. “Gutta percha” refers to inelastic natural latex made from a genus of tropical trees native to Southeast Asia. It was used starting in the 1840s to insulate transatlantic telegraph wires and to reproduce the effect of carved wood in cheap furniture.

Permalink for this paragraph0[267] Its special report was entitled “A Night Visit to the Hampstead Hospital” — a seemingly deliberate echo of Greenwood’s “A Night in the Workhouse,” but in which the author arrives unannounced at midnight and politely asks to be shown around. This “inspection” found the nursing at Hampstead mostly sufficient and concluded that the wards were “airy, spacious, warm, and sweet, and leave nothing to be desired in any way.” Despite the “sorry stuff” called beef-tea (which, after all, was not “offensively nasty”), on the whole there existed “absolutely no danger” of any patient receiving “anything but proper and kind treatment.” “A Night Visit to the Hampstead Hospital,” Lancet, 21 October 1871, 589-590.

Permalink for this paragraph0[268]Medical Press and Circular, 15 November 1871, 446. Ernest Hart, the lead organizer of the workhouse infirmaries reform association and important architect of the legislation creating the MAB, dismissed the disgruntled patients’ criticisms in toto and characterized Hampstead as an “admirable and model hospital.” Times, 2 November 1871, 11.

Permalink for this paragraph0[270]Times, 24 October 1871, 11. Wakefield said the bread was “proper.” The Times reporter helpfully adds: “This is a term in use by the witness’s class to express an idea of perfection.”

Permalink for this paragraph0[276]MAB Minutes, 6 January 1872, 551. The allegations originating from the former medical staff it ascribed to disgruntlement of young men frustrated in their professional pursuits. The “occasional and slight over-crowding” had been occasioned by the “feelings of humanity on the part of the Medical Superintentent, who desired not to reject any severe case of Smallpox which were sent to the gate of the Hospital.” MAB Minutes, 2 January 1872, 554.